{"hospital_name":"Clinton Memorial Hospital","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Clinton Memorial Hospital"],"hospital_address":["610 West Main Street, Wilmington, OH 45177"],"license_information":{"license_number":"1124","state":"OH"},"type_2_npi":["1427064641"],"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":"Janet Pavia"},"standard_charge_information":[{"description":"LIDOCAINE 2GM/D5W 500ML","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"0000000089","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.12,"discounted_cash":247.06,"setting":"both","billing_class":"facility"}]},{"description":"ALBUMIN 25% 50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"0000000374","type":"CDM"},{"code":"636","type":"RC"},{"code":"0P9047","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.32,"discounted_cash":226.16,"setting":"both","billing_class":"facility"}]},{"description":"ACYCLOVIR 500MG INJ","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000000620","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0133","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.15,"discounted_cash":451.58,"setting":"both","billing_class":"facility"}]},{"description":"D5 LR IV SOL 500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"0000000660","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7120","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.52,"discounted_cash":100.26,"setting":"both","billing_class":"facility"}]},{"description":"D5 1/4 IV SOL 500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"0000000710","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7042","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.08,"discounted_cash":131.04,"setting":"both","billing_class":"facility"}]},{"description":"D5 1/4 IV SOL 1000ML","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"0000000720","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7042","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.42,"discounted_cash":105.71,"setting":"both","billing_class":"facility"}]},{"description":"D5 1/2 IV SOL 1000ML","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"0000000750","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7042","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.01,"discounted_cash":105.00,"setting":"both","billing_class":"facility"}]},{"description":"D5 1/2 IV SOL 500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"0000000770","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7042","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.19,"discounted_cash":132.10,"setting":"both","billing_class":"facility"}]},{"description":"D5 NS IV SOL 1000ML","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"0000000800","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7042","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.01,"discounted_cash":105.00,"setting":"both","billing_class":"facility"}]},{"description":"ALLOPURINOL 100MG TAB","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000000830","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":11.38,"setting":"both","billing_class":"facility"}]},{"description":"ALLOPURINOL 300MG TAB","drug_information":{"unit":300.0,"type":"ME"},"code_information":[{"code":"0000000840","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"D5W IV SOL 50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"0000000920","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7060","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.48,"discounted_cash":106.74,"setting":"both","billing_class":"facility"}]},{"description":"D5W IV SOL 250ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"0000000940","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7060","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.98,"discounted_cash":104.49,"setting":"both","billing_class":"facility"}]},{"description":"D5W IV SOL 500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"0000000950","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7060","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.98,"discounted_cash":104.49,"setting":"both","billing_class":"facility"}]},{"description":"AMIKACIN 500MG/2ML 2ML","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000001070","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0278","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.02,"discounted_cash":257.51,"setting":"both","billing_class":"facility"}]},{"description":"VECURONIUM 20MG/ML 20ML","drug_information":{"unit":400.0,"type":"ME"},"code_information":[{"code":"0000001199","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":493.0,"setting":"both","billing_class":"facility"}]},{"description":"AMINOPHYLLINE 250MG/10ML","drug_information":{"unit":250.0,"type":"ME"},"code_information":[{"code":"0000001220","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0280","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.99,"discounted_cash":66.50,"setting":"both","billing_class":"facility"}]},{"description":"AMINOPHYLLINE 500MG/20ML","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000001270","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0280","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.44,"discounted_cash":70.72,"setting":"both","billing_class":"facility"}]},{"description":"AMPHOTERICIN B 50MG INJ","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000001750","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0285","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.85,"discounted_cash":273.92,"setting":"both","billing_class":"facility"}]},{"description":"AMPICILLIN 1GM INJ","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000001780","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0290","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.35,"discounted_cash":198.18,"setting":"both","billing_class":"facility"}]},{"description":"AMPICILLIN 250MG INJ","drug_information":{"unit":250.0,"type":"ME"},"code_information":[{"code":"0000001790","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0290","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.07,"discounted_cash":83.04,"setting":"both","billing_class":"facility"}]},{"description":"AMPICILLIN 2GM INJ","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"0000001810","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0290","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.25,"discounted_cash":208.62,"setting":"both","billing_class":"facility"}]},{"description":"AMPICILLIN 500MG INJ","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000001830","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0290","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.37,"discounted_cash":156.18,"setting":"both","billing_class":"facility"}]},{"description":"AMPICILLIN SULBACTAM 1.5","drug_information":{"unit":1.5,"type":"GM"},"code_information":[{"code":"0000001840","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0295","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.89,"discounted_cash":102.44,"setting":"both","billing_class":"facility"}]},{"description":"AMPICILLIN SULBACTAM 3GM","drug_information":{"unit":3.0,"type":"GM"},"code_information":[{"code":"0000001860","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0295","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.22,"discounted_cash":119.61,"setting":"both","billing_class":"facility"}]},{"description":"ZIDOVUDINE 10MG/ML 20ML","drug_information":{"unit":200.0,"type":"ME"},"code_information":[{"code":"0000002395","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3485","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.7,"discounted_cash":6.35,"setting":"both","billing_class":"facility"}]},{"description":"ATROPINE SUL 0.05MG/ML 5","drug_information":{"unit":0.25,"type":"ME"},"code_information":[{"code":"0000002520","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0461","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.67,"discounted_cash":113.84,"setting":"both","billing_class":"facility"}]},{"description":"ATROPINE SUL 0.4MG/ML 1M","drug_information":{"unit":0.4,"type":"ME"},"code_information":[{"code":"0000002590","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0461","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.62,"discounted_cash":77.81,"setting":"both","billing_class":"facility"}]},{"description":"ATROPINE SUL 1MG/ML 1ML","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000002620","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0461","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.36,"discounted_cash":53.18,"setting":"both","billing_class":"facility"}]},{"description":"LR IV SOL 500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"0000002670","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7120","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.5,"discounted_cash":138.25,"setting":"both","billing_class":"facility"}]},{"description":"LR IV SOL 1000ML","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"0000002680","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7120","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.02,"discounted_cash":111.51,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHLORIDE 0.45%%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"0000002720","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7040","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.31,"discounted_cash":120.66,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHLORIDE 0.45%% 1","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"0000002730","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7030","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.01,"discounted_cash":105.00,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHLORIDE 0.9%% 50","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"0000002750","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7060","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.01,"discounted_cash":105.00,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHLORIDE 0.9%% 10","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"0000002760","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7050","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.01,"discounted_cash":105.00,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHLORIDE 0.9%% 25","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"0000002770","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7050","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.19,"discounted_cash":106.10,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHLORIDE 0.9%% 50","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"0000002790","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7040","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.01,"discounted_cash":105.00,"setting":"both","billing_class":"facility"}]},{"description":"SOD CHLORIDE 0.9% 1000ML","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"0000002820","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7030","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.01,"discounted_cash":105.00,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHLORIDE 3%% 500M","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"0000002830","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7040","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.29,"discounted_cash":98.14,"setting":"both","billing_class":"facility"}]},{"description":"PROPOFOL 10MG/ML 100ML","drug_information":{"unit":1000.0,"type":"ME"},"code_information":[{"code":"0000003334","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2704","type":"HCPCS"}],"standard_charges":[{"gross_charge":1561.46,"discounted_cash":780.73,"setting":"both","billing_class":"facility"}]},{"description":"BENZTROPINE 1MG/ML 2ML","drug_information":{"unit":2.0,"type":"ME"},"code_information":[{"code":"0000003420","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0515","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.59,"discounted_cash":147.80,"setting":"both","billing_class":"facility"}]},{"description":"PAMIDRONATE 60MG INJ","drug_information":{"unit":60.0,"type":"ME"},"code_information":[{"code":"0000003939","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.58,"discounted_cash":678.29,"setting":"both","billing_class":"facility"}]},{"description":"PAMIDRONATE 90MG INJ","drug_information":{"unit":90.0,"type":"ME"},"code_information":[{"code":"0000003976","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2430","type":"HCPCS"}],"standard_charges":[{"gross_charge":10911.58,"discounted_cash":5455.79,"setting":"both","billing_class":"facility"}]},{"description":"BUMETANIDE 1MG TAB","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000004140","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.65,"discounted_cash":10.82,"setting":"both","billing_class":"facility"}]},{"description":"BUPIVACAINE 0.25%% 10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"0000004150","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.3,"discounted_cash":110.65,"setting":"both","billing_class":"facility"}]},{"description":"BUPIVACAINE 0.25% 30ML V","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"0000004170","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.07,"discounted_cash":59.54,"setting":"both","billing_class":"facility"}]},{"description":"BUPIVACAINE 0.5%% 10ML I","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"0000004190","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.12,"discounted_cash":52.06,"setting":"both","billing_class":"facility"}]},{"description":"BUPIVACAINE 0.5%% 30ML I","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"0000004210","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.3,"discounted_cash":110.65,"setting":"both","billing_class":"facility"}]},{"description":"BUPIVACAINE 0.75%% 30ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"0000004240","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.57,"discounted_cash":96.28,"setting":"both","billing_class":"facility"}]},{"description":"BUPIVACAINE/EPI 0.5%% 10","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"0000004290","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.58,"discounted_cash":41.79,"setting":"both","billing_class":"facility"}]},{"description":"DIGOXIN 0.5MG/2ML AMP","drug_information":{"unit":0.5,"type":"ME"},"code_information":[{"code":"0000004415","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1160","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.19,"discounted_cash":72.60,"setting":"both","billing_class":"facility"}]},{"description":"FLUMAZENIL 0.1 MG/ML 5ML","drug_information":{"unit":0.5,"type":"ME"},"code_information":[{"code":"0000004441","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.62,"discounted_cash":430.31,"setting":"both","billing_class":"facility"}]},{"description":"BUTORPHANOL TARTRATE 1MG","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000004460","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0595","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.78,"discounted_cash":87.89,"setting":"both","billing_class":"facility"}]},{"description":"BUTORPHANOL 2MG/ML INJ","drug_information":{"unit":2.0,"type":"ME"},"code_information":[{"code":"0000004470","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0595","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.9,"discounted_cash":114.95,"setting":"both","billing_class":"facility"}]},{"description":"METOPROLOL 25MG TAB","drug_information":{"unit":25.0,"type":"ME"},"code_information":[{"code":"0000004546","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.37,"discounted_cash":12.68,"setting":"both","billing_class":"facility"}]},{"description":"PAPAVERINE 30MG/ML 10ML","drug_information":{"unit":300.0,"type":"ME"},"code_information":[{"code":"0000004576","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2440","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.04,"discounted_cash":62.52,"setting":"both","billing_class":"facility"}]},{"description":"CALCITRIOL 1MCG/ML 1ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000004600","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0636","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.03,"discounted_cash":48.52,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 1 MCG"}]},{"description":"CALCIUM CL 10%10ML SYRG","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000004790","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.18,"discounted_cash":163.09,"setting":"both","billing_class":"facility"}]},{"description":"CALCIUM CL 10%% 10ML INJ","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000004800","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.84,"discounted_cash":55.42,"setting":"both","billing_class":"facility"}]},{"description":"METOPROLOL 50MG TAB XL","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000005107","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"CEFAZOLIN 1GM INJ","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000005610","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0690","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.23,"discounted_cash":183.62,"setting":"both","billing_class":"facility"}]},{"description":"CEFAZOLIN 500MG INJ","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000005650","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0690","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.44,"discounted_cash":108.22,"setting":"both","billing_class":"facility"}]},{"description":"CEFOTAXIME 1GM INJ","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000005790","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0698","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.17,"discounted_cash":265.58,"setting":"both","billing_class":"facility"}]},{"description":"CEFOXITIN 1GM INJ","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000005890","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0694","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.25,"discounted_cash":219.62,"setting":"both","billing_class":"facility"}]},{"description":"CEFOXITIN 2GM INJ","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"0000005900","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0694","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.05,"discounted_cash":342.02,"setting":"both","billing_class":"facility"}]},{"description":"CEFTAZIDIME 1GM INJ","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000005910","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0713","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.02,"discounted_cash":257.51,"setting":"both","billing_class":"facility"}]},{"description":"CEFTAZIDIME 2GM INJ","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"0000005930","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0713","type":"HCPCS"}],"standard_charges":[{"gross_charge":641.16,"discounted_cash":320.58,"setting":"both","billing_class":"facility"}]},{"description":"CEFTRIAXONE 1GM VIAL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000005990","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0696","type":"HCPCS"}],"standard_charges":[{"gross_charge":1086.75,"discounted_cash":543.38,"setting":"both","billing_class":"facility"}]},{"description":"CEFTRIAXONE 250MG INJ","drug_information":{"unit":250.0,"type":"ME"},"code_information":[{"code":"0000006010","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0696","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.25,"discounted_cash":219.62,"setting":"both","billing_class":"facility"}]},{"description":"CEFTRIAXONE 2GM INJ","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"0000006020","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0696","type":"HCPCS"}],"standard_charges":[{"gross_charge":1937.29,"discounted_cash":968.64,"setting":"both","billing_class":"facility"}]},{"description":"CEFTRIAXONE 500MG INJ","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000006030","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0696","type":"HCPCS"}],"standard_charges":[{"gross_charge":626.62,"discounted_cash":313.31,"setting":"both","billing_class":"facility"}]},{"description":"CEFUROXIME 750MG INJ","drug_information":{"unit":750.0,"type":"ME"},"code_information":[{"code":"0000006090","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0697","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.06,"discounted_cash":148.53,"setting":"both","billing_class":"facility"}]},{"description":"CHLOROTHIAZIDE 500MG INJ","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000006790","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1205","type":"HCPCS"}],"standard_charges":[{"gross_charge":1034.88,"discounted_cash":517.44,"setting":"both","billing_class":"facility"}]},{"description":"CHLORPROMAZINE 10MG TAB","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000006910","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q0161","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.27,"discounted_cash":12.14,"setting":"both","billing_class":"facility"}]},{"description":"CHLORPROMAZINE 25MG TAB","drug_information":{"unit":25.0,"type":"ME"},"code_information":[{"code":"0000006970","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q0161","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.65,"discounted_cash":10.82,"setting":"both","billing_class":"facility"}]},{"description":"CHLORPROMAZINE 25MG/ML 1","drug_information":{"unit":25.0,"type":"ME"},"code_information":[{"code":"0000006990","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3230","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.08,"discounted_cash":69.04,"setting":"both","billing_class":"facility"}]},{"description":"BUPIVACAINE/EPI 0.25%% 1","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"0000007066","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.92,"discounted_cash":60.46,"setting":"both","billing_class":"facility"}]},{"description":"CIPROFLOXACIN 400MG IVPB","drug_information":{"unit":400.0,"type":"ME"},"code_information":[{"code":"0000007461","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0744","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.41,"discounted_cash":304.70,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAMYCIN HCL 150MG CA","drug_information":{"unit":150.0,"type":"ME"},"code_information":[{"code":"0000007650","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAMYCIN SUSP 100ML","drug_information":{"unit":1500.0,"type":"ME"},"code_information":[{"code":"0000007670","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.5,"discounted_cash":219.25,"setting":"both","billing_class":"facility"}]},{"description":"NITROGLYCERIN 0.1MG/HR","drug_information":{"unit":0.1,"type":"ME"},"code_information":[{"code":"0000007862","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.73,"discounted_cash":12.86,"setting":"both","billing_class":"facility"}]},{"description":"D5W IV SOL 100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"0000008131","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7060","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.22,"discounted_cash":107.11,"setting":"both","billing_class":"facility"}]},{"description":"COCAINE HCL 4%% SOLN 4ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"0000008200","type":"CDM"},{"code":"636","type":"RC"},{"code":"0C9046","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.49,"discounted_cash":173.74,"setting":"both","billing_class":"facility"}]},{"description":"DOBUTAMINE 500MG/D5W 250","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000008622","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1305.47,"discounted_cash":652.74,"setting":"both","billing_class":"facility"}]},{"description":"COLISTIMETHATE 150MG INJ","drug_information":{"unit":150.0,"type":"ME"},"code_information":[{"code":"0000008630","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0770","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.17,"discounted_cash":46.08,"setting":"both","billing_class":"facility"}]},{"description":"AMIODARONE HCL 150MG/3ML","drug_information":{"unit":150.0,"type":"ME"},"code_information":[{"code":"0000008702","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0282","type":"HCPCS"}],"standard_charges":[{"gross_charge":1560.72,"discounted_cash":780.36,"setting":"both","billing_class":"facility"}]},{"description":"COSYNTROPIN 0.25MG INJ","drug_information":{"unit":0.25,"type":"ME"},"code_information":[{"code":"0000008790","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0834","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.44,"discounted_cash":108.22,"setting":"both","billing_class":"facility"}]},{"description":"CYCLOPHOSPHAMIDE 500MG I","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000009090","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J9070","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.48,"discounted_cash":247.24,"setting":"both","billing_class":"facility"}]},{"description":"MAGNESIUM SUL 50%% 20ML","drug_information":{"unit":10.0,"type":"GM"},"code_information":[{"code":"0000009516","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3475","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.28,"discounted_cash":49.64,"setting":"both","billing_class":"facility"}]},{"description":"CALCITONIN 200IU/ML 2ML","drug_information":{"unit":400.0,"type":"UN"},"code_information":[{"code":"0000009531","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0630","type":"HCPCS"}],"standard_charges":[{"gross_charge":8099.17,"discounted_cash":4049.58,"setting":"both","billing_class":"facility"}]},{"description":"DEXAMETHASONE 4MG TAB","drug_information":{"unit":4.0,"type":"ME"},"code_information":[{"code":"0000009820","type":"CDM"},{"code":"250","type":"RC"},{"code":"0J8540","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.43,"discounted_cash":10.72,"setting":"both","billing_class":"facility"}]},{"description":"DEXAMETHASONE 10MG/ML 1M","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000009880","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1100","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.03,"discounted_cash":229.52,"setting":"both","billing_class":"facility"}]},{"description":"DEXAMETH SOD PHOS 4MG/ML","drug_information":{"unit":4.0,"type":"ME"},"code_information":[{"code":"0000009920","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1100","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.36,"discounted_cash":93.68,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN 25000U/250ML D5W","drug_information":{"unit":25000.0,"type":"UN"},"code_information":[{"code":"0000010001","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1644","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.86,"discounted_cash":66.43,"setting":"both","billing_class":"facility"}]},{"description":"GENTAMICIN 20MG/2ML VIAL","drug_information":{"unit":20.0,"type":"ME"},"code_information":[{"code":"0000010047","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1580","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.34,"discounted_cash":18.67,"setting":"both","billing_class":"facility"}]},{"description":"DOLASETRON 12.5MG AMP","drug_information":{"unit":12.5,"type":"ME"},"code_information":[{"code":"0000010050","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1260","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.2,"discounted_cash":224.1,"setting":"both","billing_class":"facility"}]},{"description":"RHO(D) IMMUNE GLOB VIAL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000010059","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2790","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.43,"discounted_cash":226.72,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 300 MCG"}]},{"description":"ENOXAPARIN 30MG/0.3ML IN","drug_information":{"unit":30.0,"type":"ME"},"code_information":[{"code":"0000010082","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1650","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.7,"discounted_cash":174.85,"setting":"both","billing_class":"facility"}]},{"description":"CIDOFOVIR 375MG INJ","drug_information":{"unit":375.0,"type":"ME"},"code_information":[{"code":"0000010083","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0740","type":"HCPCS"}],"standard_charges":[{"gross_charge":4681.4,"discounted_cash":2340.7,"setting":"both","billing_class":"facility"}]},{"description":"MILRINONE 1MG/ML 20ML","drug_information":{"unit":20.0,"type":"ME"},"code_information":[{"code":"0000010119","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2522.91,"discounted_cash":1261.46,"setting":"both","billing_class":"facility"}]},{"description":"MILRINONE 20MG/100ML D5W","drug_information":{"unit":20.0,"type":"ME"},"code_information":[{"code":"0000010121","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2420.59,"discounted_cash":1210.30,"setting":"both","billing_class":"facility"}]},{"description":"FOMEPIZOLE 1GM/ML 1.5ML","drug_information":{"unit":1.5,"type":"GM"},"code_information":[{"code":"0000010132","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1451","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.26,"discounted_cash":24.63,"setting":"both","billing_class":"facility"}]},{"description":"LEVOFLOXACIN 500MG/D5W 1","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000010166","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1956","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.56,"discounted_cash":434.78,"setting":"both","billing_class":"facility"}]},{"description":"ALTEPLASE 2MG/2ML 2ML DO","drug_information":{"unit":2.0,"type":"ME"},"code_information":[{"code":"0000010171","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2997","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.21,"discounted_cash":289.60,"setting":"both","billing_class":"facility"}]},{"description":"POTASSIUM CHL 10MEQ/5ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000010199","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3480","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":27.25,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 10 MEQ"}]},{"description":"LIDOCAINE HCL/EPI 2%% 20","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"0000010213","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.07,"discounted_cash":15.04,"setting":"both","billing_class":"facility"}]},{"description":"LINEZOLID 600MG/300ML","drug_information":{"unit":600.0,"type":"ME"},"code_information":[{"code":"0000010246","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2020","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.81,"discounted_cash":201.90,"setting":"both","billing_class":"facility"}]},{"description":"PREDNISOLONE 15MG/5ML 5M","drug_information":{"unit":15.0,"type":"ME"},"code_information":[{"code":"0000010269","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7510","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"ENOXAPARIN 60MG/0.6ML","drug_information":{"unit":60.0,"type":"ME"},"code_information":[{"code":"0000010288","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1650","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.48,"discounted_cash":222.24,"setting":"both","billing_class":"facility"}]},{"description":"ENOXAPARIN 80MG/0.8ML","drug_information":{"unit":80.0,"type":"ME"},"code_information":[{"code":"0000010289","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1650","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.37,"discounted_cash":324.68,"setting":"both","billing_class":"facility"}]},{"description":"ENOXAPARIN 100MG/1.0ML","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000010291","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1274.85,"discounted_cash":637.42,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE 1MG/ML 50ML PCA","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000010425","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2270","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.72,"discounted_cash":70.36,"setting":"both","billing_class":"facility"}]},{"description":"LORAZEPAM 2MG/ML 10ML IN","drug_information":{"unit":20.0,"type":"ME"},"code_information":[{"code":"0000010441","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1561.46,"discounted_cash":780.73,"setting":"both","billing_class":"facility"}]},{"description":"DICYCLOMINE 10MG/ML 2ML","drug_information":{"unit":20.0,"type":"ME"},"code_information":[{"code":"0000010470","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0500","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.62,"discounted_cash":79.31,"setting":"both","billing_class":"facility"}]},{"description":"ROPIVACAINE 0.75%% 20ML","drug_information":{"unit":150.0,"type":"ME"},"code_information":[{"code":"0000010643","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2795","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":53.0,"setting":"both","billing_class":"facility"}]},{"description":"NITROGLYCERIN 0.2MG/HR P","drug_information":{"unit":0.2,"type":"ME"},"code_information":[{"code":"0000010726","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.74,"discounted_cash":53.37,"setting":"both","billing_class":"facility"}]},{"description":"NITROGLYCERIN 0.3MG/HR P","drug_information":{"unit":0.3,"type":"ME"},"code_information":[{"code":"0000010727","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.69,"discounted_cash":20.34,"setting":"both","billing_class":"facility"}]},{"description":"NITROGLYCERIN 0.4MG/HR P","drug_information":{"unit":0.4,"type":"ME"},"code_information":[{"code":"0000010728","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.54,"discounted_cash":22.77,"setting":"both","billing_class":"facility"}]},{"description":"MAGNESIUM SUL 40GM/1000M","drug_information":{"unit":40.0,"type":"GM"},"code_information":[{"code":"0000010749","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3475","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.02,"discounted_cash":207.51,"setting":"both","billing_class":"facility"}]},{"description":"DIGOXIN IMMUNE 40MG INJ","drug_information":{"unit":40.0,"type":"ME"},"code_information":[{"code":"0000010770","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1162","type":"HCPCS"}],"standard_charges":[{"gross_charge":19989.98,"discounted_cash":9994.99,"setting":"both","billing_class":"facility"}]},{"description":"MYCOPHENOLATE MOFET 250M","drug_information":{"unit":250.0,"type":"ME"},"code_information":[{"code":"0000010815","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7517","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.09,"discounted_cash":19.04,"setting":"both","billing_class":"facility"}]},{"description":"DILTIAZEM 30MG TAB","drug_information":{"unit":30.0,"type":"ME"},"code_information":[{"code":"0000010850","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":11.38,"setting":"both","billing_class":"facility"}]},{"description":"ROPIVACAINE 10MG/ML 20ML","drug_information":{"unit":200.0,"type":"ME"},"code_information":[{"code":"0000010853","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2795","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.12,"discounted_cash":53.56,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHLORIDE 1GM TAB","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000010854","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.65,"discounted_cash":10.82,"setting":"both","billing_class":"facility"}]},{"description":"RECOMBIVAX HB SDV 5MCG","code_information":[{"code":"0000010912","type":"CDM"},{"code":"636","type":"RC"},{"code":"090743","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.73,"discounted_cash":546.36,"setting":"both","billing_class":"facility"}]},{"description":"DIPHENHYDRAMINE ELIXIR 5","drug_information":{"unit":12.5,"type":"ME"},"code_information":[{"code":"0000011020","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q0163","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.06,"discounted_cash":5.03,"setting":"both","billing_class":"facility"}]},{"description":"DIPHENHYDRAMINE HCL 50MG","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000011140","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1200","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.88,"discounted_cash":64.94,"setting":"both","billing_class":"facility"}]},{"description":"AZITHROMYCIN 500MG INJ","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000011155","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0456","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.75,"discounted_cash":284.38,"setting":"both","billing_class":"facility"}]},{"description":"INSULIN REG HUM REC 1 UN","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"0000011177","type":"CDM"},{"code":"637","type":"RC"},{"code":"0J1815","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.24,"setting":"both","billing_class":"facility"}]},{"description":"HAEMOPHILUS B-LICTHIB","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"0000011238","type":"CDM"},{"code":"636","type":"RC"},{"code":"090648","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.57,"discounted_cash":227.28,"setting":"both","billing_class":"facility"}]},{"description":"NITROGLYCERIN OINTMENT 1","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000011263","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.03,"discounted_cash":25.02,"setting":"both","billing_class":"facility"}]},{"description":"BETAMETHASONE ACE 6MG/ML","drug_information":{"unit":30.0,"type":"ME"},"code_information":[{"code":"0000011268","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0702","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.3,"discounted_cash":87.15,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE PATCH 5%%","code_information":[{"code":"0000011329","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.85,"discounted_cash":42.92,"setting":"both","billing_class":"facility"}]},{"description":"DOBUTAMINE 250MG INJ","drug_information":{"unit":250.0,"type":"ME"},"code_information":[{"code":"0000011400","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1250","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.6,"discounted_cash":274.3,"setting":"both","billing_class":"facility"}]},{"description":"MIDAZOLAM 5MG/ML 2ML INJ","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000011438","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2250","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.72,"discounted_cash":93.86,"setting":"both","billing_class":"facility"}]},{"description":"DOPAMINE HCL 40MG/ML 5ML","drug_information":{"unit":200.0,"type":"ME"},"code_information":[{"code":"0000011540","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1265","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.78,"discounted_cash":22.39,"setting":"both","billing_class":"facility"}]},{"description":"DOXAPRAM 20MG/ML 20ML IN","drug_information":{"unit":2400.0,"type":"ME"},"code_information":[{"code":"0000011580","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1625.29,"discounted_cash":812.64,"setting":"both","billing_class":"facility"}]},{"description":"CAFFEINE CITRATE 20MG/ML","drug_information":{"unit":20.0,"type":"ME"},"code_information":[{"code":"0000011643","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0706","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.31,"discounted_cash":332.16,"setting":"both","billing_class":"facility"}]},{"description":"POTASSIUM CL 10MEQ/100ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000011702","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3480","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.98,"discounted_cash":132.49,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 10 MEQ"}]},{"description":"DOXYCYCLINE HYCLATE 100M","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000011710","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.48,"discounted_cash":28.74,"setting":"both","billing_class":"facility"}]},{"description":"DOXYCYCLINE 100MG INJ","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000011730","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1202.08,"discounted_cash":601.04,"setting":"both","billing_class":"facility"}]},{"description":"DROPERIDOL 2.5MG/ML 2ML","drug_information":{"unit":5.0,"type":"ME"},"code_information":[{"code":"0000011810","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1790","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.37,"discounted_cash":92.18,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN FLUSH 10U/ML 5ML","drug_information":{"unit":50.0,"type":"UN"},"code_information":[{"code":"0000012395","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1642","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.91,"discounted_cash":8.96,"setting":"both","billing_class":"facility"}]},{"description":"IBUTILIDE 0.1MG/ML 10ML","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000012405","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1742","type":"HCPCS"}],"standard_charges":[{"gross_charge":971.06,"discounted_cash":485.53,"setting":"both","billing_class":"facility"}]},{"description":"BUPIVACAINE HCL/DEXTR 2M","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"0000012444","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.78,"discounted_cash":34.89,"setting":"both","billing_class":"facility"}]},{"description":"ERYTHROMYCIN LACT 500MG","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000012880","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1364","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.99,"discounted_cash":184.00,"setting":"both","billing_class":"facility"}]},{"description":"ESTRADIOL 5MG/ML 1ML INJ","drug_information":{"unit":5.0,"type":"ME"},"code_information":[{"code":"0000013030","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1000","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.52,"discounted_cash":231.76,"setting":"both","billing_class":"facility"}]},{"description":"ETOMIDATE 2MG/ML 2OML IN","drug_information":{"unit":40.0,"type":"ME"},"code_information":[{"code":"0000013480","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.62,"discounted_cash":233.81,"setting":"both","billing_class":"facility"}]},{"description":"FAMOTIDINE 10MG/ML 2ML I","drug_information":{"unit":20.0,"type":"ME"},"code_information":[{"code":"0000013530","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.99,"discounted_cash":104.50,"setting":"both","billing_class":"facility"}]},{"description":"FAMOTIDINE 20MG TAB","drug_information":{"unit":20.0,"type":"ME"},"code_information":[{"code":"0000013550","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.27,"discounted_cash":12.14,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL CIT 0.05MG/ML 2","drug_information":{"unit":0.1,"type":"ME"},"code_information":[{"code":"0000013720","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3010","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.09,"discounted_cash":119.04,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL CIT 0.05MG/ML 5","drug_information":{"unit":0.25,"type":"ME"},"code_information":[{"code":"0000013730","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3010","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.09,"discounted_cash":119.04,"setting":"both","billing_class":"facility"}]},{"description":"FLUCONAZOLE 200MG/100ML","drug_information":{"unit":200.0,"type":"ME"},"code_information":[{"code":"0000014170","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1450","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.63,"discounted_cash":453.82,"setting":"both","billing_class":"facility"}]},{"description":"FLUCONAZOLE 400MG/200ML","drug_information":{"unit":400.0,"type":"ME"},"code_information":[{"code":"0000014190","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.36,"discounted_cash":830.18,"setting":"both","billing_class":"facility"}]},{"description":"HEPATIT B VIR VACC 10MCG","code_information":[{"code":"0000014209","type":"CDM"},{"code":"636","type":"RC"},{"code":"090744","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.7,"discounted_cash":549.35,"setting":"both","billing_class":"facility"}]},{"description":"MAGNESIUM SUL 40MG/ML 50","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"0000014497","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3475","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.55,"discounted_cash":33.78,"setting":"both","billing_class":"facility"}]},{"description":"FLUOROURACIL 50MG/ML 10M","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000014520","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J9190","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.56,"discounted_cash":32.28,"setting":"both","billing_class":"facility"}]},{"description":"FLUCONAZOLE 100MG/50ML","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000014525","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1450","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.01,"discounted_cash":491.50,"setting":"both","billing_class":"facility"}]},{"description":"FOLIC ACID 1MG TAB","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000014800","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.95,"discounted_cash":5.98,"setting":"both","billing_class":"facility"}]},{"description":"FOLIC ACID 5MG/ML 10ML I","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000014830","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.66,"discounted_cash":60.83,"setting":"both","billing_class":"facility"}]},{"description":"GENTAMICIN SUL 40MG/ML 2","drug_information":{"unit":80.0,"type":"ME"},"code_information":[{"code":"0000015170","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1580","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.1,"discounted_cash":41.05,"setting":"both","billing_class":"facility"}]},{"description":"GLUCAGON 1MG INJ","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000015280","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1327.1,"discounted_cash":663.55,"setting":"both","billing_class":"facility"}]},{"description":"GLYCOPYRROLATE 1MG TAB","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000015530","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.65,"discounted_cash":10.82,"setting":"both","billing_class":"facility"}]},{"description":"DEXAMETHASONE 4MG/ML 5ML","drug_information":{"unit":20.0,"type":"ME"},"code_information":[{"code":"0000016085","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1100","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.75,"discounted_cash":100.38,"setting":"both","billing_class":"facility"}]},{"description":"HALOPERIDOL 5MG/ML 1ML I","drug_information":{"unit":5.0,"type":"ME"},"code_information":[{"code":"0000016540","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1630","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.59,"discounted_cash":68.30,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN SODIUM 10000U IN","drug_information":{"unit":10000.0,"type":"UN"},"code_information":[{"code":"0000016750","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1644","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.72,"discounted_cash":118.86,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN SODIUM 1000U INJ","drug_information":{"unit":1000.0,"type":"UN"},"code_information":[{"code":"0000016770","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1644","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.12,"discounted_cash":53.56,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN SODIUM 100U/ML 1","drug_information":{"unit":100.0,"type":"UN"},"code_information":[{"code":"0000016800","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1642","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.39,"discounted_cash":50.20,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN SOD 100U/ML 5ML","drug_information":{"unit":500.0,"type":"UN"},"code_information":[{"code":"0000016815","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1642","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.78,"discounted_cash":8.39,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN SOD 5000U 1ML IN","drug_information":{"unit":5000.0,"type":"UN"},"code_information":[{"code":"0000016880","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1644","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.59,"discounted_cash":68.30,"setting":"both","billing_class":"facility"}]},{"description":"HEPATITIS B IMMUNE GLOB","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"0000016910","type":"CDM"},{"code":"636","type":"RC"},{"code":"090371","type":"HCPCS"}],"standard_charges":[{"gross_charge":885.21,"discounted_cash":442.60,"setting":"both","billing_class":"facility"}]},{"description":"HEPATITIS B IMMUGLOB 1ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"0000016920","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1571","type":"HCPCS"}],"standard_charges":[{"gross_charge":3181.52,"discounted_cash":1590.76,"setting":"both","billing_class":"facility"}]},{"description":"OLANZAPINE 5MG TAB","drug_information":{"unit":5.0,"type":"ME"},"code_information":[{"code":"0000017159","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.32,"discounted_cash":59.16,"setting":"both","billing_class":"facility"}]},{"description":"HYDRALAZINE 20MG/ML 1ML","drug_information":{"unit":20.0,"type":"ME"},"code_information":[{"code":"0000017190","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0360","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.02,"discounted_cash":101.51,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCORTISONE 100MG INJ","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000017660","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1720","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.89,"discounted_cash":89.94,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCORTISONE 250MG INJ","drug_information":{"unit":250.0,"type":"ME"},"code_information":[{"code":"0000017670","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1720","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.21,"discounted_cash":133.60,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCORTISONE 500MG INJ","drug_information":{"unit":3.0,"type":"ME"},"code_information":[{"code":"0000017680","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1720","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":277.0,"setting":"both","billing_class":"facility"}]},{"description":"HYDROXYZINE 25MG/ML 1ML","drug_information":{"unit":25.0,"type":"ME"},"code_information":[{"code":"0000017940","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3410","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.73,"discounted_cash":67.36,"setting":"both","billing_class":"facility"}]},{"description":"HYDROXYZINE PAMOATE 25MG","drug_information":{"unit":25.0,"type":"ME"},"code_information":[{"code":"0000017990","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q0177","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"KETOROLAC 30MG/ML INJ","drug_information":{"unit":30.0,"type":"ME"},"code_information":[{"code":"0000019920","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.62,"discounted_cash":119.81,"setting":"both","billing_class":"facility"}]},{"description":"KETOROLAC 60MG/2ML INJ","drug_information":{"unit":60.0,"type":"ME"},"code_information":[{"code":"0000019930","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.6,"discounted_cash":143.3,"setting":"both","billing_class":"facility"}]},{"description":"LABETALOL 100MG TAB","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000019960","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"LABETALOL 200MG TAB","drug_information":{"unit":200.0,"type":"ME"},"code_information":[{"code":"0000019970","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 4%% SOLN 50ML","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"0000020950","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.16,"discounted_cash":100.58,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE HCL 5% OINT 35","drug_information":{"unit":35.0,"type":"GM"},"code_information":[{"code":"0000020980","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.42,"discounted_cash":47.21,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE HCL/EPI 1%% 20","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"0000021030","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.8,"discounted_cash":58.4,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 2%% EPI 1:1000","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"0000021070","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.01,"discounted_cash":11.00,"setting":"both","billing_class":"facility"}]},{"description":"CEFEPIME 1GM INJ","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000021161","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0692","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.92,"discounted_cash":163.46,"setting":"both","billing_class":"facility"}]},{"description":"FOSPHENYTOIN 50MG/ML 2ML","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000021167","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q2009","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.69,"discounted_cash":240.34,"setting":"both","billing_class":"facility"}]},{"description":"FOSPHENYTOIN 50MG/ML 10M","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000021168","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q2009","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.99,"discounted_cash":504.00,"setting":"both","billing_class":"facility"}]},{"description":"LORAZEPAM 2MG/ML INJ","drug_information":{"unit":2.0,"type":"ME"},"code_information":[{"code":"0000021540","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2060","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.89,"discounted_cash":89.94,"setting":"both","billing_class":"facility"}]},{"description":"MAGNESIUM SULFATE 50%% 2","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000022100","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3475","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.88,"discounted_cash":64.94,"setting":"both","billing_class":"facility"}]},{"description":"MEPERIDINE 100MG/ML 1ML","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000022580","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2175","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.61,"discounted_cash":26.30,"setting":"both","billing_class":"facility"}]},{"description":"METHOCARBAMOL 100MG/ML 1","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"0000023360","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2800","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.18,"discounted_cash":76.09,"setting":"both","billing_class":"facility"}]},{"description":"METHOTREXATE 2.5MG TAB","drug_information":{"unit":2.5,"type":"ME"},"code_information":[{"code":"0000023430","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J8610","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.42,"discounted_cash":36.21,"setting":"both","billing_class":"facility"}]},{"description":"METHYLDOPATE 250MG/5ML 5","drug_information":{"unit":250.0,"type":"ME"},"code_information":[{"code":"0000023720","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0210","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.59,"discounted_cash":147.80,"setting":"both","billing_class":"facility"}]},{"description":"METHYLERGONOVINE 0.2MG/M","drug_information":{"unit":0.2,"type":"ME"},"code_information":[{"code":"0000023760","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2210","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.62,"discounted_cash":79.31,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPREDNISOLONE 4MG T","drug_information":{"unit":4.0,"type":"ME"},"code_information":[{"code":"0000023830","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7509","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.46,"discounted_cash":11.23,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPREDNISOLONE 1000M","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000023890","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2930","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.53,"discounted_cash":292.76,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPREDNISOLONE 2GM I","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"0000023911","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2930","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.98,"discounted_cash":118.49,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPREDNISOLONE 500MG","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000023920","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2930","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.98,"discounted_cash":118.49,"setting":"both","billing_class":"facility"}]},{"description":"METOCLOPRAMIDE 5MG/ML 2M","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000024020","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2765","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.59,"discounted_cash":68.30,"setting":"both","billing_class":"facility"}]},{"description":"METOPROLOL 50MG TAB","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000024110","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"METRONIDAZOLE 250MG TAB","drug_information":{"unit":250.0,"type":"ME"},"code_information":[{"code":"0000024140","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"METRONIDAZOLE 500MG TAB","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000024150","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.46,"discounted_cash":17.73,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE VISCOUS 2%% 10","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"0000024409","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.51,"discounted_cash":38.26,"setting":"both","billing_class":"facility"}]},{"description":"MIDAZOLAM 1MG/ML 2ML INJ","drug_information":{"unit":2.0,"type":"ME"},"code_information":[{"code":"0000024430","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2250","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.33,"discounted_cash":70.16,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE SULFATE 10MG/ML","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000025000","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2270","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.9,"discounted_cash":114.95,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE 10MG/10ML 10ML","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000025031","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2270","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.21,"discounted_cash":133.60,"setting":"both","billing_class":"facility"}]},{"description":"NALBUPHINE HCL 10MG/ML 1","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000025760","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2300","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.99,"discounted_cash":104.50,"setting":"both","billing_class":"facility"}]},{"description":"NEOSTIGMINE 1:1000 10ML","drug_information":{"unit":0.5,"type":"ME"},"code_information":[{"code":"0000026480","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2710","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.94,"discounted_cash":86.47,"setting":"both","billing_class":"facility"}]},{"description":"LEVOFLOXACIN 250MG/50ML","drug_information":{"unit":250.0,"type":"ME"},"code_information":[{"code":"0000026752","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1956","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.89,"discounted_cash":152.44,"setting":"both","billing_class":"facility"}]},{"description":"NITROGLYCERIN 0.4MG SL T","drug_information":{"unit":0.4,"type":"ME"},"code_information":[{"code":"0000026930","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"NITROGLYCERIN AEROSOL 14","drug_information":{"unit":14.0,"type":"GM"},"code_information":[{"code":"0000026940","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.65,"discounted_cash":152.82,"setting":"both","billing_class":"facility"}]},{"description":"NITROGLYCERIN 2.5MG CAP","drug_information":{"unit":2.5,"type":"ME"},"code_information":[{"code":"0000027030","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.13,"discounted_cash":11.56,"setting":"both","billing_class":"facility"}]},{"description":"NITROGLYCERIN 5MG/ML 10M","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000027120","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.78,"discounted_cash":100.39,"setting":"both","billing_class":"facility"}]},{"description":"NITROGLYCERIN 6.5MG SA C","drug_information":{"unit":6.5,"type":"ME"},"code_information":[{"code":"0000027130","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":11.38,"setting":"both","billing_class":"facility"}]},{"description":"ORPHENADRINE 30MG/ML 2ML","drug_information":{"unit":60.0,"type":"ME"},"code_information":[{"code":"0000027650","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2360","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.3,"discounted_cash":165.15,"setting":"both","billing_class":"facility"}]},{"description":"OXACILLIN 1GM INJ","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000027710","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2700","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.31,"discounted_cash":241.66,"setting":"both","billing_class":"facility"}]},{"description":"OXACILLIN 2GM INJ","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"0000027740","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2700","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.67,"discounted_cash":48.34,"setting":"both","billing_class":"facility"}]},{"description":"LEUPROLIDE 11.25MG DEPOT","drug_information":{"unit":11.25,"type":"ME"},"code_information":[{"code":"0000027902","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1950","type":"HCPCS"}],"standard_charges":[{"gross_charge":6885.89,"discounted_cash":3442.94,"setting":"both","billing_class":"facility"}]},{"description":"OXYTOCIN 10U/ML 1ML INJ","drug_information":{"unit":10.0,"type":"UN"},"code_information":[{"code":"0000028080","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2590","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.59,"discounted_cash":68.30,"setting":"both","billing_class":"facility"}]},{"description":"PAPAVERINE 30MG/ML 2ML","drug_information":{"unit":60.0,"type":"ME"},"code_information":[{"code":"0000028300","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2440","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.77,"discounted_cash":25.38,"setting":"both","billing_class":"facility"}]},{"description":"DIAZEPAM 5MG/ML 1ML","drug_information":{"unit":5.0,"type":"ME"},"code_information":[{"code":"0000028479","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3360","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.03,"discounted_cash":25.02,"setting":"both","billing_class":"facility"}]},{"description":"PENICILLIN G BENZ 600MU/","drug_information":{"unit":600000.0,"type":"UN"},"code_information":[{"code":"0000028680","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0561","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.93,"discounted_cash":85.46,"setting":"both","billing_class":"facility"}]},{"description":"PENICILLIN G BENZ 1.2MU/","drug_information":{"unit":1200000.0,"type":"UN"},"code_information":[{"code":"0000028690","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0561","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.28,"discounted_cash":140.14,"setting":"both","billing_class":"facility"}]},{"description":"PENICILLIN G POT 5MMU","drug_information":{"unit":5000000.0,"type":"UN"},"code_information":[{"code":"0000028810","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2540","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.37,"discounted_cash":156.18,"setting":"both","billing_class":"facility"}]},{"description":"PENTAMIDINE ISETH 300MG","drug_information":{"unit":300.0,"type":"ME"},"code_information":[{"code":"0000028970","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2545","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.94,"discounted_cash":678.47,"setting":"both","billing_class":"facility"}]},{"description":"PERPHENAZINE 4MG TAB","drug_information":{"unit":4.0,"type":"ME"},"code_information":[{"code":"0000029330","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q0175","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.37,"discounted_cash":14.18,"setting":"both","billing_class":"facility"}]},{"description":"MEROPENEM 1GM INJ","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000029463","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2185","type":"HCPCS"}],"standard_charges":[{"gross_charge":703.11,"discounted_cash":351.56,"setting":"both","billing_class":"facility"}]},{"description":"PHENOBARBITAL 65MG INJ","drug_information":{"unit":65.0,"type":"ME"},"code_information":[{"code":"0000029560","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2560","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.43,"discounted_cash":86.22,"setting":"both","billing_class":"facility"}]},{"description":"PHENTOLAMINE 5MG INJ","drug_information":{"unit":5.0,"type":"ME"},"code_information":[{"code":"0000029720","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1081.15,"discounted_cash":540.58,"setting":"both","billing_class":"facility"}]},{"description":"PHENYTOIN SOD 50MG/ML 2M","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000030270","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1165","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.41,"discounted_cash":98.70,"setting":"both","billing_class":"facility"}]},{"description":"PHENYTOIN SOD 50MG/ML 5M","drug_information":{"unit":250.0,"type":"ME"},"code_information":[{"code":"0000030280","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1165","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.29,"discounted_cash":151.14,"setting":"both","billing_class":"facility"}]},{"description":"PHYTONADIONE 10MG/ML 1ML","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000030380","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3430","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.59,"discounted_cash":68.30,"setting":"both","billing_class":"facility"}]},{"description":"PHYTONADIONE 1MG/0.5ML I","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000030400","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3430","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.62,"discounted_cash":79.31,"setting":"both","billing_class":"facility"}]},{"description":"CIPROFLOXACIN 200MG IVPB","drug_information":{"unit":200.0,"type":"ME"},"code_information":[{"code":"0000030982","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0744","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.21,"discounted_cash":174.10,"setting":"both","billing_class":"facility"}]},{"description":"MEROPENEM 500MG INJ","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000031044","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2185","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.58,"discounted_cash":278.79,"setting":"both","billing_class":"facility"}]},{"description":"POTASSIUM CL 2MEQ/ML 10M","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000031200","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3480","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.44,"discounted_cash":97.22,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 20 MEQ"}]},{"description":"POTASSIUM CL 2MEQ/ML 15M","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000031220","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3480","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.44,"discounted_cash":97.22,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 30 MEQ"}]},{"description":"POTASSIUM CL 2MEQ/ML 20M","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000031230","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3480","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.37,"discounted_cash":129.68,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 40 MEQ"}]},{"description":"PROCAINAMIDE HCL 100MG/M","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000032030","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2690","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.97,"discounted_cash":260.48,"setting":"both","billing_class":"facility"}]},{"description":"ROPIVACAINE 5MG/ML 30ML","drug_information":{"unit":150.0,"type":"ME"},"code_information":[{"code":"0000032073","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2795","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":53.0,"setting":"both","billing_class":"facility"}]},{"description":"PROCHLORPERAZINE 5MG/ML","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000032180","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0780","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.99,"discounted_cash":67.00,"setting":"both","billing_class":"facility"}]},{"description":"PROCHLORPERAZINE 10MG TA","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000032210","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q0164","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.54,"discounted_cash":11.77,"setting":"both","billing_class":"facility"}]},{"description":"PROCHLORPERAZINE 5MG TAB","drug_information":{"unit":5.0,"type":"ME"},"code_information":[{"code":"0000032280","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q0164","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.13,"discounted_cash":11.56,"setting":"both","billing_class":"facility"}]},{"description":"PROMETHAZINE 25MG TAB","drug_information":{"unit":25.0,"type":"ME"},"code_information":[{"code":"0000032430","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q0169","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"PROMETHAZINE HCL 25MG/ML","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000032450","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2550","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.62,"discounted_cash":79.31,"setting":"both","billing_class":"facility"}]},{"description":"METRONIDAZOLE CRM 0.75%%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"0000032455","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.52,"discounted_cash":543.76,"setting":"both","billing_class":"facility"}]},{"description":"PROPOFOL 10MG/ML 20ML","drug_information":{"unit":200.0,"type":"ME"},"code_information":[{"code":"0000032580","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2704","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.39,"discounted_cash":142.20,"setting":"both","billing_class":"facility"}]},{"description":"PROPOFOL 10MG/ML 50ML","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000032585","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2704","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.13,"discounted_cash":334.06,"setting":"both","billing_class":"facility"}]},{"description":"PROPRANOLOL 1MG/ML INJ","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000032720","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1800","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.46,"discounted_cash":145.73,"setting":"both","billing_class":"facility"}]},{"description":"RIFAMPIN 600MG INJ","drug_information":{"unit":600.0,"type":"ME"},"code_information":[{"code":"0000033915","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1542.81,"discounted_cash":771.40,"setting":"both","billing_class":"facility"}]},{"description":"RIFAMPIN 300MG CAP","drug_information":{"unit":300.0,"type":"ME"},"code_information":[{"code":"0000033920","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.82,"discounted_cash":17.91,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM ACETATE 2MEQ/ML 2","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000034420","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.93,"discounted_cash":21.46,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 40 MEQ"}]},{"description":"ACETAZOLAMIDE 500MG 1ML","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000034430","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1120","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.07,"discounted_cash":278.04,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHL NASAL SPRAY 4","code_information":[{"code":"0000034550","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.58,"discounted_cash":46.29,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHLOR 0.9%% 10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"0000034620","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.01,"discounted_cash":11.00,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHLORIDE 5%% GTTS","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"0000034730","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.07,"discounted_cash":122.04,"setting":"both","billing_class":"facility"}]},{"description":"SUCCINYLCHOLINE 20MG/ML","drug_information":{"unit":200.0,"type":"ME"},"code_information":[{"code":"0000035260","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0330","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.62,"discounted_cash":79.31,"setting":"both","billing_class":"facility"}]},{"description":"TERBUTALINE 1MG/ML 1ML I","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000035980","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3105","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.59,"discounted_cash":68.30,"setting":"both","billing_class":"facility"}]},{"description":"TESTOSTERONE 200MG/ML 1M","drug_information":{"unit":200.0,"type":"ME"},"code_information":[{"code":"0000036150","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1071","type":"HCPCS"}],"standard_charges":[{"gross_charge":1605.13,"discounted_cash":802.56,"setting":"both","billing_class":"facility"}]},{"description":"TET IMMUNE GLOB 250U VIA","drug_information":{"unit":250.0,"type":"UN"},"code_information":[{"code":"0000036240","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1670","type":"HCPCS"}],"standard_charges":[{"gross_charge":2759.43,"discounted_cash":1379.72,"setting":"both","billing_class":"facility"}]},{"description":"TET DIP TOX ADULT 0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"0000036300","type":"CDM"},{"code":"636","type":"RC"},{"code":"090714","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.27,"discounted_cash":121.64,"setting":"both","billing_class":"facility"}]},{"description":"TOBRAMYCIN 80MG/2ML INJ","drug_information":{"unit":80.0,"type":"ME"},"code_information":[{"code":"0000037690","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.93,"discounted_cash":138.46,"setting":"both","billing_class":"facility"}]},{"description":"TRIAMCINOLONE ACET 40MG/","drug_information":{"unit":40.0,"type":"ME"},"code_information":[{"code":"0000038100","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3301","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.97,"discounted_cash":80.98,"setting":"both","billing_class":"facility"}]},{"description":"TACROLIMUS 1MG CAP","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000038732","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7507","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.01,"discounted_cash":26.50,"setting":"both","billing_class":"facility"}]},{"description":"VECURONIUM 10MG INJ","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000039060","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.57,"discounted_cash":252.28,"setting":"both","billing_class":"facility"}]},{"description":"DILTIAZEM 180MG CD CAP","drug_information":{"unit":180.0,"type":"ME"},"code_information":[{"code":"0000040620","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":410.7,"setting":"both","billing_class":"facility"}]},{"description":"DILTIAZEM HCL 240MG CAPS","drug_information":{"unit":240.0,"type":"ME"},"code_information":[{"code":"0000040630","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL CITRATE .05MG/M","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000040680","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3010","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.71,"discounted_cash":265.36,"setting":"both","billing_class":"facility"}]},{"description":"LEUPROLIDE 7.5MG KIT","drug_information":{"unit":7.5,"type":"ME"},"code_information":[{"code":"0000041470","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J9217","type":"HCPCS"}],"standard_charges":[{"gross_charge":1875.41,"discounted_cash":937.70,"setting":"both","billing_class":"facility"}]},{"description":"DESMOPRESSIN ACETATE 4MC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000043800","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2597","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.64,"discounted_cash":23.32,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 4 MCG"}]},{"description":"OCTREOTIDE 0.1MG/ML INJ","drug_information":{"unit":0.1,"type":"ME"},"code_information":[{"code":"0000043850","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2354","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.89,"discounted_cash":102.44,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN 1000U .9%% NS 50","drug_information":{"unit":1000.0,"type":"UN"},"code_information":[{"code":"0000044556","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1644","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.33,"discounted_cash":134.16,"setting":"both","billing_class":"facility"}]},{"description":"PROTAMINE SULFATE 10MG/M","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000044690","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2720","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.01,"discounted_cash":11.00,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHLORIDE 5%% OINT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"0000045650","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.71,"discounted_cash":81.36,"setting":"both","billing_class":"facility"}]},{"description":"HYOSCYAMINE 0.5MG/ML INJ","drug_information":{"unit":0.5,"type":"ME"},"code_information":[{"code":"0000046910","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1980","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":13.25,"setting":"both","billing_class":"facility"}]},{"description":"DILTIAZEM CD 120MG CAP","drug_information":{"unit":120.0,"type":"ME"},"code_information":[{"code":"0000047020","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":11.38,"setting":"both","billing_class":"facility"}]},{"description":"RIFAMPIN 150MG CAP","drug_information":{"unit":150.0,"type":"ME"},"code_information":[{"code":"0000048030","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.13,"discounted_cash":14.56,"setting":"both","billing_class":"facility"}]},{"description":"SUMATRIPTAN 6MG 0.5ML IN","drug_information":{"unit":6.0,"type":"ME"},"code_information":[{"code":"0000048050","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3030","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.55,"discounted_cash":164.78,"setting":"both","billing_class":"facility"}]},{"description":"ENOXAPARIN 40MG/0.4ML IN","drug_information":{"unit":40.0,"type":"ME"},"code_information":[{"code":"0000048370","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1650","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.64,"discounted_cash":115.32,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAMYCIN 2%% 40GM VAG","drug_information":{"unit":40.0,"type":"GM"},"code_information":[{"code":"0000048430","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.4,"discounted_cash":217.2,"setting":"both","billing_class":"facility"}]},{"description":"ONDANSETRON 2MG/ML 2ML I","drug_information":{"unit":2.0,"type":"ME"},"code_information":[{"code":"0000048555","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2405","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.16,"discounted_cash":167.58,"setting":"both","billing_class":"facility"}]},{"description":"DRONABINOL 2.5MG CAP","drug_information":{"unit":2.5,"type":"ME"},"code_information":[{"code":"0000048790","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q0167","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.63,"discounted_cash":40.32,"setting":"both","billing_class":"facility"}]},{"description":"MEDROXYPROGESTERONE 150M","drug_information":{"unit":150.0,"type":"ME"},"code_information":[{"code":"0000048950","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1050","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.44,"discounted_cash":108.22,"setting":"both","billing_class":"facility"}]},{"description":"NITROGLYCERIN 50MG/D5W 2","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000049025","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.78,"discounted_cash":178.39,"setting":"both","billing_class":"facility"}]},{"description":"METRONIDAZOLE 0.75%% 70G","drug_information":{"unit":70.0,"type":"GM"},"code_information":[{"code":"0000050080","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.73,"discounted_cash":338.86,"setting":"both","billing_class":"facility"}]},{"description":"ZOSYN 3/.375 GM","drug_information":{"unit":3.375,"type":"GM"},"code_information":[{"code":"0000070000","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2543","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.73,"discounted_cash":145.36,"setting":"both","billing_class":"facility"}]},{"description":"CEFUROXIME 1.5GM INJ","drug_information":{"unit":1.5,"type":"GM"},"code_information":[{"code":"0000070019","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0697","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.58,"discounted_cash":18.29,"setting":"both","billing_class":"facility"}]},{"description":"DOPAMINE 1.6MG/ML/D5W 25","drug_information":{"unit":400.0,"type":"ME"},"code_information":[{"code":"0000078791","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1265","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.57,"discounted_cash":227.28,"setting":"both","billing_class":"facility"}]},{"description":"THIAMINE HCL 100MG/ML 2M","drug_information":{"unit":200.0,"type":"ME"},"code_information":[{"code":"0000079222","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3411","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.17,"discounted_cash":22.58,"setting":"both","billing_class":"facility"}]},{"description":"ERTAPENEM 1GM INJ","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000081069","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1335","type":"HCPCS"}],"standard_charges":[{"gross_charge":719.54,"discounted_cash":359.77,"setting":"both","billing_class":"facility"}]},{"description":"SOD CH .45%% 20MEQ KCL 1","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000081104","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3480","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.38,"discounted_cash":207.69,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 20 MEQ"}]},{"description":"DAPTOMYCIN 1MG INJ","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000081177","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0878","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.97,"discounted_cash":2.98,"setting":"both","billing_class":"facility"}]},{"description":"ACETYLCYSTEINE 200MG/ML","drug_information":{"unit":6000.0,"type":"ME"},"code_information":[{"code":"0000081182","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0132","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.91,"discounted_cash":8.96,"setting":"both","billing_class":"facility"}]},{"description":"ZIPRASIDONE 20MG INJ","drug_information":{"unit":20.0,"type":"ME"},"code_information":[{"code":"0000081202","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3486","type":"HCPCS"}],"standard_charges":[{"gross_charge":787.46,"discounted_cash":393.73,"setting":"both","billing_class":"facility"}]},{"description":"MICAFUNGIN 50MG INJ","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000081227","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2248","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.84,"discounted_cash":3.92,"setting":"both","billing_class":"facility"}]},{"description":"ZOLEDRONIC ACID 5MG 100M","drug_information":{"unit":5.0,"type":"ME"},"code_information":[{"code":"0000081241","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3489","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.56,"discounted_cash":161.78,"setting":"both","billing_class":"facility"}]},{"description":"MICAFUNGIN 100MG INJ","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000081257","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2248","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.84,"discounted_cash":3.92,"setting":"both","billing_class":"facility"}]},{"description":"RABIES VACCINE IM","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"0000081298","type":"CDM"},{"code":"636","type":"RC"},{"code":"090675","type":"HCPCS"}],"standard_charges":[{"gross_charge":2009.67,"discounted_cash":1004.84,"setting":"both","billing_class":"facility"}]},{"description":"EPOETIN ALFA 1000U/0.05M","drug_information":{"unit":1000.0,"type":"UN"},"code_information":[{"code":"0000081305","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0885","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.39,"discounted_cash":50.20,"setting":"both","billing_class":"facility"}]},{"description":"MAGNESIUM SUL 40MG/ML 50","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"0000081595","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3475","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.25,"discounted_cash":104.12,"setting":"both","billing_class":"facility"}]},{"description":"OLANZAPINE 10MG INJ","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000081632","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2358","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"ROPIVACAINE 5MG/ML 20ML","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000081668","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2795","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.76,"discounted_cash":37.88,"setting":"both","billing_class":"facility"}]},{"description":"OXYTOCIN 30U NS 500ML","drug_information":{"unit":30.0,"type":"UN"},"code_information":[{"code":"0000081833","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2590","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.89,"discounted_cash":127.44,"setting":"both","billing_class":"facility"}]},{"description":"ESOMEPRAZOLE 40MG INJ","drug_information":{"unit":40.0,"type":"ME"},"code_information":[{"code":"0000082039","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.26,"discounted_cash":191.63,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL 10MCG/ML 100ML","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000082154","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3010","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.44,"discounted_cash":70.72,"setting":"both","billing_class":"facility"}]},{"description":"LEVETIRACETAM 500MG/5ML","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000082168","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1953","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.45,"discounted_cash":262.72,"setting":"both","billing_class":"facility"}]},{"description":"BICILLIN CR 1.2MM 2ML","drug_information":{"unit":1200000.0,"type":"UN"},"code_information":[{"code":"0000082282","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0558","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.77,"discounted_cash":233.88,"setting":"both","billing_class":"facility"}]},{"description":"BOOSTRIX VACCINE","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"0000082445","type":"CDM"},{"code":"636","type":"RC"},{"code":"090715","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.66,"discounted_cash":254.33,"setting":"both","billing_class":"facility"}]},{"description":"CEFTAROLINE 600MG INJ","drug_information":{"unit":600.0,"type":"ME"},"code_information":[{"code":"0000082797","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0712","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.96,"discounted_cash":302.48,"setting":"both","billing_class":"facility"}]},{"description":"HYALURONIDASE HUM REC 15","drug_information":{"unit":150.0,"type":"UN"},"code_information":[{"code":"0000083171","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3473","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.63,"discounted_cash":221.32,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 2%% VISCOUS 15","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"0000083366","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.47,"discounted_cash":3.74,"setting":"both","billing_class":"facility"}]},{"description":"ALTEPLASE 100MG INJ","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000096666","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2997","type":"HCPCS"}],"standard_charges":[{"gross_charge":58015.16,"discounted_cash":29007.58,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR VIII AHF HUMAN PE","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"0000097036","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7190","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.84,"discounted_cash":3.92,"setting":"both","billing_class":"facility"}]},{"description":"FERRIC GLUCONATE COMP 62","drug_information":{"unit":62.5,"type":"ME"},"code_information":[{"code":"0000097037","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2916","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.32,"discounted_cash":135.66,"setting":"both","billing_class":"facility"}]},{"description":"ZOLEDRONIC ACID 4MG INJ","drug_information":{"unit":4.0,"type":"ME"},"code_information":[{"code":"0000097064","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3489","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.56,"discounted_cash":161.78,"setting":"both","billing_class":"facility"}]},{"description":"METOPROLOL XL 25MG TAB","drug_information":{"unit":25.0,"type":"ME"},"code_information":[{"code":"0000097188","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"DOPAMINE 400MG/10ML INJ","drug_information":{"unit":400.0,"type":"ME"},"code_information":[{"code":"0000097289","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1265","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.46,"discounted_cash":13.23,"setting":"both","billing_class":"facility"}]},{"description":"LEVOFLOXACIN 750MG/150ML","drug_information":{"unit":750.0,"type":"ME"},"code_information":[{"code":"0000097747","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1956","type":"HCPCS"}],"standard_charges":[{"gross_charge":1190.52,"discounted_cash":595.26,"setting":"both","billing_class":"facility"}]},{"description":"DEXAMETHASONE 1MG TAB","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000100049","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J8540","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.81,"discounted_cash":6.90,"setting":"both","billing_class":"facility"}]},{"description":"POTASSIUM CL 20MEQ/100ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000100052","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3480","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.33,"discounted_cash":201.16,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 20 MEQ"}]},{"description":"GANCICLOVIR 500MG INJ","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000100053","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1570","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.16,"discounted_cash":308.08,"setting":"both","billing_class":"facility"}]},{"description":"METHYLENE BLUE 1%% 1ML I","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"0000100055","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q9968","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.45,"discounted_cash":44.22,"setting":"both","billing_class":"facility"}]},{"description":"ROPIVACAINE 2MG/ML 20ML","drug_information":{"unit":40.0,"type":"ME"},"code_information":[{"code":"0000100056","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2795","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.23,"discounted_cash":27.62,"setting":"both","billing_class":"facility"}]},{"description":"ADACEL VACCINE","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"0000100057","type":"CDM"},{"code":"636","type":"RC"},{"code":"090715","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.83,"discounted_cash":236.42,"setting":"both","billing_class":"facility"}]},{"description":"ESTROGEN CONJ 25MG INJ","drug_information":{"unit":25.0,"type":"ME"},"code_information":[{"code":"0000100059","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1410","type":"HCPCS"}],"standard_charges":[{"gross_charge":1614.07,"discounted_cash":807.04,"setting":"both","billing_class":"facility"}]},{"description":"HALOPERIDOL DEC 50MG/ML","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000100061","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1631","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.47,"discounted_cash":147.24,"setting":"both","billing_class":"facility"}]},{"description":"CYANOCOBALAMIN 1000MCG/M","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000100067","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3420","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.15,"discounted_cash":63.08,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 1000 MCG"}]},{"description":"ATROPINE SUL 0.1MG 10ML","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000100068","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0461","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.37,"discounted_cash":156.18,"setting":"both","billing_class":"facility"}]},{"description":"D5W IV SOL 1000ML","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"0000100081","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7070","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.07,"discounted_cash":105.54,"setting":"both","billing_class":"facility"}]},{"description":"DIPYRIDAMOLE 5MG/ML 10ML","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000100265","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1245","type":"HCPCS"}],"standard_charges":[{"gross_charge":2743.02,"discounted_cash":1371.51,"setting":"both","billing_class":"facility"}]},{"description":"PEGFILGRAS-JMDB 6MG INJ","drug_information":{"unit":6.0,"type":"ME"},"code_information":[{"code":"0000100269","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q5108","type":"HCPCS"}],"standard_charges":[{"gross_charge":29634.55,"discounted_cash":14817.28,"setting":"both","billing_class":"facility"}]},{"description":"VORICONAZOLE 200MG/20ML","drug_information":{"unit":200.0,"type":"ME"},"code_information":[{"code":"0000100270","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3465","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.36,"discounted_cash":15.68,"setting":"both","billing_class":"facility"}]},{"description":"PAMIDRONATE 30MG INJ","drug_information":{"unit":30.0,"type":"ME"},"code_information":[{"code":"0000100272","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2430","type":"HCPCS"}],"standard_charges":[{"gross_charge":3981.64,"discounted_cash":1990.82,"setting":"both","billing_class":"facility"}]},{"description":"AZATHIOPRINE 50MG TAB","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000100274","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7500","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":11.38,"setting":"both","billing_class":"facility"}]},{"description":"AMPHOTERICIN B LIPOS 50M","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000100276","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0287","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.8,"discounted_cash":72.4,"setting":"both","billing_class":"facility"}]},{"description":"SYNAGIS 100MG VIAL","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000100286","type":"CDM"},{"code":"636","type":"RC"},{"code":"090378","type":"HCPCS"}],"standard_charges":[{"gross_charge":16489.4,"discounted_cash":8244.7,"setting":"both","billing_class":"facility"}]},{"description":"SYNAGIS 50MG VIAL","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000100287","type":"CDM"},{"code":"636","type":"RC"},{"code":"090378","type":"HCPCS"}],"standard_charges":[{"gross_charge":16489.4,"discounted_cash":8244.7,"setting":"both","billing_class":"facility"}]},{"description":"RABIES IMM GLOB 150U/ML","drug_information":{"unit":300.0,"type":"UN"},"code_information":[{"code":"0000100288","type":"CDM"},{"code":"636","type":"RC"},{"code":"090375","type":"HCPCS"}],"standard_charges":[{"gross_charge":2101.86,"discounted_cash":1050.93,"setting":"both","billing_class":"facility"}]},{"description":"RABIES IMM GLOB 150U/ML","drug_information":{"unit":150.0,"type":"UN"},"code_information":[{"code":"0000100289","type":"CDM"},{"code":"636","type":"RC"},{"code":"090375","type":"HCPCS"}],"standard_charges":[{"gross_charge":2101.86,"discounted_cash":1050.93,"setting":"both","billing_class":"facility"}]},{"description":"CEFEPIME HCL 2G VL","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"0000100708","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0692","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.85,"discounted_cash":326.92,"setting":"both","billing_class":"facility"}]},{"description":"DEXTRAN 40 500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"0000100713","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7100","type":"HCPCS"}],"standard_charges":[{"gross_charge":607.94,"discounted_cash":303.97,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN 1000 U LOCK","drug_information":{"unit":1000.0,"type":"UN"},"code_information":[{"code":"0000100717","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1642","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.87,"discounted_cash":103.94,"setting":"both","billing_class":"facility"}]},{"description":"PRALIDOXIME 1G INJ","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000100736","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2730","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.2,"discounted_cash":394.1,"setting":"both","billing_class":"facility"}]},{"description":"DEFEROXAMINE 500 MG VIAL","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000101084","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0895","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.95,"discounted_cash":43.48,"setting":"both","billing_class":"facility"}]},{"description":"D5W IV SOL 250ML NON-PVC","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"0000101085","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7060","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.19,"discounted_cash":32.10,"setting":"both","billing_class":"facility"}]},{"description":"LIDO/EPI 1.5%-1:200K 5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"0000101087","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.09,"discounted_cash":19.04,"setting":"both","billing_class":"facility"}]},{"description":"MEPERIDINE INJ 25MG 1 VL","drug_information":{"unit":25.0,"type":"ME"},"code_information":[{"code":"0000101091","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2175","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.99,"discounted_cash":104.50,"setting":"both","billing_class":"facility"}]},{"description":"PREDNISONE 10MG TAB","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000101268","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7512","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"PREDNISONE 20MG TAB","drug_information":{"unit":20.0,"type":"ME"},"code_information":[{"code":"0000101269","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7512","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"PREDNISONE 5MG TAB","drug_information":{"unit":5.0,"type":"ME"},"code_information":[{"code":"0000101270","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7512","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"TBO-FILGRASTIM 300MCG/.5","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000101271","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1938.75,"discounted_cash":969.38,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 300 MCG"}]},{"description":"TBO-FILGRASTIM 480MCG/.8","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000101272","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1447","type":"HCPCS"}],"standard_charges":[{"gross_charge":2514.23,"discounted_cash":1257.12,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 480 MCG"}]},{"description":"D5LR 1000ML","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"0000101273","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7121","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.74,"discounted_cash":104.87,"setting":"both","billing_class":"facility"}]},{"description":"DORNASE ALFA 2.5MG/2.5ML","drug_information":{"unit":2.5,"type":"ME"},"code_information":[{"code":"0000101353","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7639","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.31,"discounted_cash":474.16,"setting":"both","billing_class":"facility"}]},{"description":"ACETAMINOPHEN 1000MG VL","drug_information":{"unit":1000.0,"type":"ME"},"code_information":[{"code":"0000101357","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0131","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.33,"discounted_cash":160.66,"setting":"both","billing_class":"facility"}]},{"description":"DEFEROXAMINE 2GM VIAL","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"0000101358","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0895","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.19,"discounted_cash":97.60,"setting":"both","billing_class":"facility"}]},{"description":"ZERBAXA 1.5 GM VIAL","drug_information":{"unit":1.5,"type":"GM"},"code_information":[{"code":"0000101396","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0695","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.87,"discounted_cash":389.44,"setting":"both","billing_class":"facility"}]},{"description":"ASCORBIC ACID 500 MG/ML","code_information":[{"code":"0000101455","type":"CDM"},{"code":"636","type":"RC"},{"code":"0A9152","type":"HCPCS"}],"standard_charges":[{"gross_charge":809.47,"discounted_cash":404.74,"setting":"both","billing_class":"facility"}]},{"description":"ARGATROBAN 100MG/ML 2.5M","drug_information":{"unit":250.0,"type":"ME"},"code_information":[{"code":"0000101456","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0883","type":"HCPCS"}],"standard_charges":[{"gross_charge":2365.34,"discounted_cash":1182.67,"setting":"both","billing_class":"facility"}]},{"description":"ALTEPLASE 100 MG JW MOD","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000101493","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2997JW","type":"HCPCS"}],"standard_charges":[{"gross_charge":58015.16,"discounted_cash":29007.58,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHL 0.9% MB+ 100","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"0000101511","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7050","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.66,"discounted_cash":130.33,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHL 0.9% 25ML","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"0000101512","type":"CDM"},{"code":"258","type":"RC"},{"code":"0J7050","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.66,"discounted_cash":130.33,"setting":"both","billing_class":"facility"}]},{"description":"NEXPLANON 68 MG IMPLANT","code_information":[{"code":"0000101524","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7307","type":"HCPCS"}],"standard_charges":[{"gross_charge":5417.34,"discounted_cash":2708.67,"setting":"both","billing_class":"facility"}]},{"description":"METHYLENE BLUE 50MG/10ML","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000101542","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q9968","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.71,"discounted_cash":638.36,"setting":"both","billing_class":"facility"}]},{"description":"CYCLOSPORIN 50MG/ML 5ML","drug_information":{"unit":250.0,"type":"ME"},"code_information":[{"code":"0000101551","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7516","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.83,"discounted_cash":118.42,"setting":"both","billing_class":"facility"}]},{"description":"FENT/NS 10MCG/ML 250ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000101587","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3010","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.72,"discounted_cash":164.86,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 2500 MCG"}]},{"description":"MIRENA 52MG IUD","drug_information":{"unit":52.0,"type":"ME"},"code_information":[{"code":"0000101589","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7298","type":"HCPCS"}],"standard_charges":[{"gross_charge":5259.55,"discounted_cash":2629.78,"setting":"both","billing_class":"facility"}]},{"description":"CANGRELOR 50MG VIAL","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000101689","type":"CDM"},{"code":"636","type":"RC"},{"code":"0C9460","type":"HCPCS"}],"standard_charges":[{"gross_charge":3884.88,"discounted_cash":1942.44,"setting":"both","billing_class":"facility"}]},{"description":"NEOSTIGMINE 5MG/5ML SYR","drug_information":{"unit":0.5,"type":"ME"},"code_information":[{"code":"0000101702","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2710","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.88,"discounted_cash":41.94,"setting":"both","billing_class":"facility"}]},{"description":"EPOETIN EPBX 10000 UN/ML","drug_information":{"unit":10000.0,"type":"UN"},"code_information":[{"code":"0000101704","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q5106","type":"HCPCS"}],"standard_charges":[{"gross_charge":974.63,"discounted_cash":487.32,"setting":"both","billing_class":"facility"}]},{"description":"EPOETIN EPBX 4000 UN/ML","drug_information":{"unit":4000.0,"type":"UN"},"code_information":[{"code":"0000101705","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q5106","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.86,"discounted_cash":194.93,"setting":"both","billing_class":"facility"}]},{"description":"EPOETIN EPBX 40000 UN/ML","drug_information":{"unit":40000.0,"type":"UN"},"code_information":[{"code":"0000101706","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q5106","type":"HCPCS"}],"standard_charges":[{"gross_charge":3898.52,"discounted_cash":1949.26,"setting":"both","billing_class":"facility"}]},{"description":"FERAHEME 510MG/17ML VIAL","drug_information":{"unit":510.0,"type":"ME"},"code_information":[{"code":"0000101791","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q0139","type":"HCPCS"}],"standard_charges":[{"gross_charge":7303.06,"discounted_cash":3651.53,"setting":"both","billing_class":"facility"}]},{"description":"TIROFIBAN 3.75MG/15ML SY","drug_information":{"unit":3.75,"type":"ME"},"code_information":[{"code":"0000101792","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1723.97,"discounted_cash":861.98,"setting":"both","billing_class":"facility"}]},{"description":"TIROFIBAN 5MG/100ML PB","drug_information":{"unit":5.0,"type":"ME"},"code_information":[{"code":"0000101793","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1915.5,"discounted_cash":957.75,"setting":"both","billing_class":"facility"}]},{"description":"STREPTOMYCIN 1GM VIAL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000101808","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3000","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.25,"discounted_cash":297.62,"setting":"both","billing_class":"facility"}]},{"description":"OCTAGAM 10% VIAL","drug_information":{"unit":10.0,"type":"GM"},"code_information":[{"code":"0000101809","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1568","type":"HCPCS"}],"standard_charges":[{"gross_charge":4936.41,"discounted_cash":2468.20,"setting":"both","billing_class":"facility"}]},{"description":"MITOMYCIN-C 40MG SYR","drug_information":{"unit":40.0,"type":"ME"},"code_information":[{"code":"0000101817","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J9280","type":"HCPCS"}],"standard_charges":[{"gross_charge":8556.54,"discounted_cash":4278.27,"setting":"both","billing_class":"facility"}]},{"description":"ADENOSINE 3MG/ML 20ML","drug_information":{"unit":60.0,"type":"ME"},"code_information":[{"code":"0000101820","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0153","type":"HCPCS"}],"standard_charges":[{"gross_charge":5261.05,"discounted_cash":2630.52,"setting":"both","billing_class":"facility"}]},{"description":"GENTAMICIN 80MG/100ML PB","drug_information":{"unit":80.0,"type":"ME"},"code_information":[{"code":"0000101841","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1580","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.83,"discounted_cash":118.42,"setting":"both","billing_class":"facility"}]},{"description":"MITOMYCIN 20MG/40ML SYR","drug_information":{"unit":20.0,"type":"ME"},"code_information":[{"code":"0000101856","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J9280","type":"HCPCS"}],"standard_charges":[{"gross_charge":4278.26,"discounted_cash":2139.13,"setting":"both","billing_class":"facility"}]},{"description":"FORMOTEROL 20MCG/2ML NEB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000102100","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7606","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.87,"discounted_cash":22.44,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 20 MCG"}]},{"description":"HUMALOG KWIKPEN 3ML","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"0000102116","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1815","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.26,"discounted_cash":69.13,"setting":"both","billing_class":"facility"}]},{"description":"FERAHEME 510MG NON-ESRD","drug_information":{"unit":510.0,"type":"ME"},"code_information":[{"code":"0000102160","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q0138","type":"HCPCS"}],"standard_charges":[{"gross_charge":6955.29,"discounted_cash":3477.64,"setting":"both","billing_class":"facility"}]},{"description":"VARICELLA VACCINE 0.5ML","code_information":[{"code":"0000102191","type":"CDM"},{"code":"636","type":"RC"},{"code":"090716","type":"HCPCS"}],"standard_charges":[{"gross_charge":1480.91,"discounted_cash":740.46,"setting":"both","billing_class":"facility"}]},{"description":"SUBUTEX 8MG TAB","drug_information":{"unit":8.0,"type":"ME"},"code_information":[{"code":"0000102197","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0571","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.04,"discounted_cash":11.52,"setting":"both","billing_class":"facility"}]},{"description":"ENTYVIO 300MG VIAL","drug_information":{"unit":300.0,"type":"ME"},"code_information":[{"code":"0000102215","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3380","type":"HCPCS"}],"standard_charges":[{"gross_charge":17352.62,"discounted_cash":8676.31,"setting":"both","billing_class":"facility"}]},{"description":"ANTIVENIN CROTALIDAE","drug_information":{"unit":120.0,"type":"ME"},"code_information":[{"code":"0000102221","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0841","type":"HCPCS"}],"standard_charges":[{"gross_charge":4349.47,"discounted_cash":2174.74,"setting":"both","billing_class":"facility"}]},{"description":"SINCALIDE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0000102226","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2805","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.72,"discounted_cash":203.36,"setting":"both","billing_class":"facility","additional_generic_notes":"EA = 5 MCG"}]},{"description":"MENINGOCOCCAL GRB B VACC","code_information":[{"code":"0000102240","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1034.81,"discounted_cash":517.40,"setting":"both","billing_class":"facility"}]},{"description":"EPOPROSTENOL 1.5MG VIAL","drug_information":{"unit":1.5,"type":"ME"},"code_information":[{"code":"0000102248","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1325","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.46,"discounted_cash":128.73,"setting":"both","billing_class":"facility"}]},{"description":"ABATCEPT 250MG VIAL","drug_information":{"unit":250.0,"type":"ME"},"code_information":[{"code":"0000102257","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0129","type":"HCPCS"}],"standard_charges":[{"gross_charge":6729.89,"discounted_cash":3364.94,"setting":"both","billing_class":"facility"}]},{"description":"REMDESIVIR 100MG VIAL","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000102261","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0248","type":"HCPCS"}],"standard_charges":[{"gross_charge":2994.71,"discounted_cash":1497.36,"setting":"both","billing_class":"facility"}]},{"description":"MIDAZOLAM 50MG/50ML NS","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000102263","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2250","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.59,"discounted_cash":54.30,"setting":"both","billing_class":"facility"}]},{"description":"BEBTELOVIMAB 175MG INJ","drug_information":{"unit":175.0,"type":"ME"},"code_information":[{"code":"0000102264","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q0222","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility"}]},{"description":"KEDRAB 150UN/ML 2ML","drug_information":{"unit":150.0,"type":"UN"},"code_information":[{"code":"0000102268","type":"CDM"},{"code":"636","type":"RC"},{"code":"090377","type":"HCPCS"}],"standard_charges":[{"gross_charge":1850.92,"discounted_cash":925.46,"setting":"both","billing_class":"facility"}]},{"description":"KEDRAB 1500 UNITS/10 ML","drug_information":{"unit":1500.0,"type":"UN"},"code_information":[{"code":"0000102269","type":"CDM"},{"code":"636","type":"RC"},{"code":"090377","type":"HCPCS"}],"standard_charges":[{"gross_charge":9254.57,"discounted_cash":4627.28,"setting":"both","billing_class":"facility"}]},{"description":"TENECTEPLASE 50MG JW","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000102293","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3101","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.72,"discounted_cash":354.36,"setting":"both","billing_class":"facility"}]},{"description":"MIDAZOLAM 100MG/100ML","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000102306","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2251","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.07,"discounted_cash":74.54,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE 2MG/ML PFS","drug_information":{"unit":2.0,"type":"ME"},"code_information":[{"code":"0000102307","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2272","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.9,"discounted_cash":101.45,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE 4MG/ML PFS","drug_information":{"unit":4.0,"type":"ME"},"code_information":[{"code":"0000102308","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2272","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.9,"discounted_cash":101.45,"setting":"both","billing_class":"facility"}]},{"description":"MOXIFLOXACIN 400MG PB","drug_information":{"unit":400.0,"type":"ME"},"code_information":[{"code":"0000102309","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3371","type":"HCPCS"}],"standard_charges":[{"gross_charge":831.91,"discounted_cash":415.96,"setting":"both","billing_class":"facility"}]},{"description":"KEDRAB 1500 UNIT/10ML JW","drug_information":{"unit":1500.0,"type":"UN"},"code_information":[{"code":"0000102312","type":"CDM"},{"code":"636","type":"RC"},{"code":"090377","type":"HCPCS"}],"standard_charges":[{"gross_charge":9254.57,"discounted_cash":4627.28,"setting":"both","billing_class":"facility"}]},{"description":"CHLOROPROCAINE 3% 20ML","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000102315","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2401","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.29,"discounted_cash":72.64,"setting":"both","billing_class":"facility"}]},{"description":"CHLOROPROCAINE 3% 30ML","code_information":[{"code":"0000102316","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2401","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.13,"discounted_cash":259.06,"setting":"both","billing_class":"facility"}]},{"description":"PREVNAR 20 PFS 0.5ML","code_information":[{"code":"0000102329","type":"CDM"},{"code":"636","type":"RC"},{"code":"090677","type":"HCPCS"}],"standard_charges":[{"gross_charge":2893.91,"discounted_cash":1446.96,"setting":"both","billing_class":"facility"}]},{"description":"INFLIXIMAB-ABDA 100MG","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000102331","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q5104","type":"HCPCS"}],"standard_charges":[{"gross_charge":6290.0,"discounted_cash":3145.0,"setting":"both","billing_class":"facility"}]},{"description":"CALC GLU 1GM/50ML PB","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000102335","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0613","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.76,"discounted_cash":69.38,"setting":"both","billing_class":"facility"}]},{"description":"CALC GLU 1GM/10ML VIAL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000102336","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0612","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.61,"discounted_cash":66.30,"setting":"both","billing_class":"facility"}]},{"description":"ADENOSINE 6MG/2ML VIAL","drug_information":{"unit":6.0,"type":"ME"},"code_information":[{"code":"0000102344","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0153","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.1,"discounted_cash":263.05,"setting":"both","billing_class":"facility"}]},{"description":"CLINDA 300MG/50ML NS BAX","drug_information":{"unit":300.0,"type":"ME"},"code_information":[{"code":"0000102345","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0737","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.43,"discounted_cash":300.22,"setting":"both","billing_class":"facility"}]},{"description":"CLINDA 600MG/50ML NS BAX","drug_information":{"unit":600.0,"type":"ME"},"code_information":[{"code":"0000102346","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0737","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.65,"discounted_cash":426.82,"setting":"both","billing_class":"facility"}]},{"description":"CLINDA 900MG/50ML NS BAX","drug_information":{"unit":900.0,"type":"ME"},"code_information":[{"code":"0000102347","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0737","type":"HCPCS"}],"standard_charges":[{"gross_charge":1097.87,"discounted_cash":548.94,"setting":"both","billing_class":"facility"}]},{"description":"ESMOLOL 10MG/ML 10ML","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000102348","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1806","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.98,"discounted_cash":191.49,"setting":"both","billing_class":"facility"}]},{"description":"ESMOLOL PREMIX 10MG/ML","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000102349","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1806","type":"HCPCS"}],"standard_charges":[{"gross_charge":1635.14,"discounted_cash":817.57,"setting":"both","billing_class":"facility"}]},{"description":"LABETALOL 5MG/ML 4ML","drug_information":{"unit":5.0,"type":"ME"},"code_information":[{"code":"0000102350","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1920","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.05,"discounted_cash":219.02,"setting":"both","billing_class":"facility"}]},{"description":"LABETALOL 5MG/ML 20ML","drug_information":{"unit":5.0,"type":"ME"},"code_information":[{"code":"0000102351","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1920","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.99,"discounted_cash":225.50,"setting":"both","billing_class":"facility"}]},{"description":"VASOPRESSIN 20U/ML 1ML","drug_information":{"unit":20.0,"type":"UN"},"code_information":[{"code":"0000102352","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2598","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.9,"discounted_cash":103.45,"setting":"both","billing_class":"facility"}]},{"description":"VASOPRESSIN 20U/100ML","drug_information":{"unit":20.0,"type":"UN"},"code_information":[{"code":"0000102353","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2598","type":"HCPCS"}],"standard_charges":[{"gross_charge":1267.87,"discounted_cash":633.94,"setting":"both","billing_class":"facility"}]},{"description":"METRONIDAZOLE 500MG/100M","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000102354","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1836","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.4,"discounted_cash":362.7,"setting":"both","billing_class":"facility"}]},{"description":"AZTREONAM 1GM INJ","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000102355","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0457","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.49,"discounted_cash":201.74,"setting":"both","billing_class":"facility"}]},{"description":"AZTREONAM 2GM INJ","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"0000102356","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0457","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.7,"discounted_cash":293.85,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAMYCIN 300MG/2ML","drug_information":{"unit":300.0,"type":"ME"},"code_information":[{"code":"0000102357","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0736","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.81,"discounted_cash":192.40,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAMYCIN 900MG/6ML","drug_information":{"unit":900.0,"type":"ME"},"code_information":[{"code":"0000102358","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0736","type":"HCPCS"}],"standard_charges":[{"gross_charge":881.56,"discounted_cash":440.78,"setting":"both","billing_class":"facility"}]},{"description":"PHENYLEPHRINE 10MG/ML","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000102360","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2371","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility"}]},{"description":"PHENYLEPHRINE 0.5MG/5ML","drug_information":{"unit":0.5,"type":"ME"},"code_information":[{"code":"0000102361","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2372","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.52,"discounted_cash":9.26,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE 1MG/ML 100ML BA","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000102368","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2270","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.23,"discounted_cash":136.62,"setting":"both","billing_class":"facility"}]},{"description":"DILTIAZEM 125MG/125ML NS","code_information":[{"code":"0000102369","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2825.65,"discounted_cash":1412.82,"setting":"both","billing_class":"facility"}]},{"description":"BUMETANIDE 1MG/4ML INJ","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000102380","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1939","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.32,"discounted_cash":68.66,"setting":"both","billing_class":"facility"}]},{"description":"GLYCOPYRROLATE 0.6MG/3ML","drug_information":{"unit":0.6,"type":"ME"},"code_information":[{"code":"0000102381","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1596","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.68,"discounted_cash":154.84,"setting":"both","billing_class":"facility"}]},{"description":"NICARDIPINE 25MG/10MLINJ","drug_information":{"unit":25.0,"type":"ME"},"code_information":[{"code":"0000102383","type":"CDM"},{"code":"250","type":"RC"},{"code":"0J2404","type":"HCPCS"}],"standard_charges":[{"gross_charge":2998.54,"discounted_cash":1499.27,"setting":"both","billing_class":"facility"}]},{"description":"NICARDIPINE 40MG/200ML","drug_information":{"unit":40.0,"type":"ME"},"code_information":[{"code":"0000102393","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2404","type":"HCPCS"}],"standard_charges":[{"gross_charge":6176.99,"discounted_cash":3088.50,"setting":"both","billing_class":"facility"}]},{"description":"RSV VACC 120MCG/0.5ML","code_information":[{"code":"0000102394","type":"CDM"},{"code":"636","type":"RC"},{"code":"090678","type":"HCPCS"}],"standard_charges":[{"gross_charge":6988.55,"discounted_cash":3494.28,"setting":"both","billing_class":"facility"}]},{"description":"GLYCOPYRROLATE 0.2MG/ML","drug_information":{"unit":0.2,"type":"ME"},"code_information":[{"code":"0000102397","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1596","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.87,"discounted_cash":57.44,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPRED SOD SUCC 125M","drug_information":{"unit":125.0,"type":"ME"},"code_information":[{"code":"0000102425","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2919","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.3,"discounted_cash":299.65,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPRED SOD SUCC 40MG","drug_information":{"unit":40.0,"type":"ME"},"code_information":[{"code":"0000102426","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2919","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.9,"discounted_cash":90.95,"setting":"both","billing_class":"facility"}]},{"description":"4F-PCC 500 UNITS","drug_information":{"unit":500.0,"type":"UN"},"code_information":[{"code":"0000102430","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J7165","type":"HCPCS"}],"standard_charges":[{"gross_charge":5978.41,"discounted_cash":2989.20,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPRED ACE 40MG/ML","drug_information":{"unit":40.0,"type":"ME"},"code_information":[{"code":"0000102431","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1010","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.27,"discounted_cash":89.14,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPRED ACE 80MG/ML","drug_information":{"unit":80.0,"type":"ME"},"code_information":[{"code":"0000102432","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1010","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.21,"discounted_cash":184.60,"setting":"both","billing_class":"facility"}]},{"description":"METHOTREXATE 25MG/ML 4ML","drug_information":{"unit":25.0,"type":"ME"},"code_information":[{"code":"0000102433","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J9260","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.09,"discounted_cash":100.54,"setting":"both","billing_class":"facility"}]},{"description":"PANTOPRAZOLE 40MG INJ","drug_information":{"unit":40.0,"type":"ME"},"code_information":[{"code":"0000102440","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2470","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.9,"discounted_cash":38.95,"setting":"both","billing_class":"facility"}]},{"description":"HYDROMORPHONE 0.5MG PFS","drug_information":{"unit":0.5,"type":"ME"},"code_information":[{"code":"0000102449","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1171","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.75,"discounted_cash":33.88,"setting":"both","billing_class":"facility"}]},{"description":"HYDROMORPHONE 1MG PFS","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000102450","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1171","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.51,"discounted_cash":67.76,"setting":"both","billing_class":"facility"}]},{"description":"HYDROMORPHONE","drug_information":{"unit":0.1,"type":"ME"},"code_information":[{"code":"0000102451","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1171","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.3,"discounted_cash":97.65,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 2% 400MG INJ","drug_information":{"unit":400.0,"type":"ME"},"code_information":[{"code":"0000102468","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2003","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.08,"discounted_cash":117.04,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 1% 300MG INJ","drug_information":{"unit":300.0,"type":"ME"},"code_information":[{"code":"0000102469","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2003","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 1% 500MG INJ","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000102470","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2003","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.22,"discounted_cash":84.61,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 1% 200MG INJ","drug_information":{"unit":200.0,"type":"ME"},"code_information":[{"code":"0000102472","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2003","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.08,"discounted_cash":117.04,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 2% 1000MG INJ","drug_information":{"unit":1000.0,"type":"ME"},"code_information":[{"code":"0000102473","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2003","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.66,"discounted_cash":72.83,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 2% MPF 40MG IN","drug_information":{"unit":40.0,"type":"ME"},"code_information":[{"code":"0000102474","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2003","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.93,"discounted_cash":11.96,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 2% 100MG INJ","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000102475","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2003","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.68,"discounted_cash":31.34,"setting":"both","billing_class":"facility"}]},{"description":"HYDROMORPH 0.2MG/ML PCA","drug_information":{"unit":0.2,"type":"ME"},"code_information":[{"code":"0000102476","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1171","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.5,"discounted_cash":193.25,"setting":"both","billing_class":"facility"}]},{"description":"HYDROXOCOBALAMIN 5GM KIT","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"0000102486","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3424","type":"HCPCS"}],"standard_charges":[{"gross_charge":4241.01,"discounted_cash":2120.50,"setting":"both","billing_class":"facility"}]},{"description":"RITUXIMAB 100MG VIAL","drug_information":{"unit":100.0,"type":"ME"},"code_information":[{"code":"0000102489","type":"CDM"},{"code":"636","type":"RC"},{"code":"0Q5119","type":"HCPCS"}],"standard_charges":[{"gross_charge":3956.79,"discounted_cash":1978.40,"setting":"both","billing_class":"facility"}]},{"description":"JW GLYCOPYROLATE .6MG/3M","drug_information":{"unit":0.6,"type":"ME"},"code_information":[{"code":"0000102490","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1596JW","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.68,"discounted_cash":154.84,"setting":"both","billing_class":"facility"}]},{"description":"JW GLYCOPYROLATE .2MG/ML","drug_information":{"unit":0.2,"type":"ME"},"code_information":[{"code":"0000102491","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1596JW","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.87,"discounted_cash":57.44,"setting":"both","billing_class":"facility"}]},{"description":"TENECTEPLASE 50MG IV","drug_information":{"unit":50.0,"type":"ME"},"code_information":[{"code":"0000102500","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3101","type":"HCPCS"}],"standard_charges":[{"gross_charge":38167.4,"discounted_cash":19083.7,"setting":"both","billing_class":"facility"}]},{"description":"TENECTEPLASE 25MG IV","drug_information":{"unit":25.0,"type":"ME"},"code_information":[{"code":"0000102501","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3101","type":"HCPCS"}],"standard_charges":[{"gross_charge":19083.7,"discounted_cash":9541.85,"setting":"both","billing_class":"facility"}]},{"description":"FUROSEMIDE 10MG/ML 10ML","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000102503","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1938","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.92,"discounted_cash":111.96,"setting":"both","billing_class":"facility"}]},{"description":"JW HYDROMORPHONE 0.5MG P","drug_information":{"unit":0.5,"type":"ME"},"code_information":[{"code":"0000102504","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1171JW","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.75,"discounted_cash":33.88,"setting":"both","billing_class":"facility"}]},{"description":"JW HYDROMORPHONE 1MG PFS","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000102505","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1171JW","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.51,"discounted_cash":67.76,"setting":"both","billing_class":"facility"}]},{"description":"FUROSEMIDE 10MG/ML 2ML","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000102506","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1938","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.61,"discounted_cash":66.30,"setting":"both","billing_class":"facility"}]},{"description":"FUROSEMIDE 10MG/ML 4ML","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000102507","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1938","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility"}]},{"description":"JW OLANZAPINE 10MG","drug_information":{"unit":10.0,"type":"ME"},"code_information":[{"code":"0000102518","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2358JW","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.93,"discounted_cash":11.96,"setting":"both","billing_class":"facility"}]},{"description":"EPINEPHRINE 1MG INJ","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000102523","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0165","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.55,"discounted_cash":19.78,"setting":"both","billing_class":"facility"}]},{"description":"EPINEPHRINE 1MG/10ML SYR","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000102524","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0165","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.68,"discounted_cash":158.34,"setting":"both","billing_class":"facility"}]},{"description":"METOPROLOL 5MG/5ML INJ","drug_information":{"unit":5.0,"type":"ME"},"code_information":[{"code":"0000102525","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0616","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.18,"discounted_cash":76.09,"setting":"both","billing_class":"facility"}]},{"description":"NALOXONE 0.4MG INJ","drug_information":{"unit":0.4,"type":"ME"},"code_information":[{"code":"0000102526","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2312","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.54,"discounted_cash":63.77,"setting":"both","billing_class":"facility"}]},{"description":"DILTIAZEM 125MG/25ML","drug_information":{"unit":125.0,"type":"ME"},"code_information":[{"code":"0000102527","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1163","type":"HCPCS"}],"standard_charges":[{"gross_charge":2619.63,"discounted_cash":1309.82,"setting":"both","billing_class":"facility"}]},{"description":"DILTIAZEM 25MG/5ML INJ","drug_information":{"unit":25.0,"type":"ME"},"code_information":[{"code":"0000102528","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1163","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.56,"discounted_cash":211.78,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 500MG VIAL","drug_information":{"unit":500.0,"type":"ME"},"code_information":[{"code":"0000102529","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3373","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.06,"discounted_cash":283.53,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 1GM VIAL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000102530","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3373","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.39,"discounted_cash":123.20,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 750MG PREMIX","drug_information":{"unit":750.0,"type":"ME"},"code_information":[{"code":"0000102531","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3375","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.39,"discounted_cash":123.20,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 1GM PREMIX","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"0000102532","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3375","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.4,"discounted_cash":226.2,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 1.25GM PREMIX","drug_information":{"unit":1.25,"type":"GM"},"code_information":[{"code":"0000102533","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3375","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.99,"discounted_cash":154.00,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 1.5GM PREMIX","drug_information":{"unit":1.5,"type":"GM"},"code_information":[{"code":"0000102534","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3375","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.58,"discounted_cash":184.79,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 1.75GM PREMIX","drug_information":{"unit":1.75,"type":"GM"},"code_information":[{"code":"0000102535","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3375","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.18,"discounted_cash":215.59,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 2GM","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"0000102536","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3375","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.77,"discounted_cash":246.38,"setting":"both","billing_class":"facility"}]},{"description":"BIVALIRUDIN 250MG/50ML","drug_information":{"unit":250.0,"type":"ME"},"code_information":[{"code":"0000102553","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0583","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.4,"discounted_cash":193.2,"setting":"both","billing_class":"facility"}]},{"description":"ONABOTULINUMTOXIN A 100","drug_information":{"unit":100.0,"type":"UN"},"code_information":[{"code":"0000102614","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J0585","type":"HCPCS"}],"standard_charges":[{"gross_charge":3592.6,"discounted_cash":1796.3,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN SODIUM 1000U INJ","drug_information":{"unit":1000.0,"type":"UN"},"code_information":[{"code":"0000102621","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1644","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":52.0,"setting":"both","billing_class":"facility"}]},{"description":"TIROFIBAN 12.5MG/250ML","drug_information":{"unit":12.5,"type":"ME"},"code_information":[{"code":"0000102628","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3246","type":"HCPCS"}],"standard_charges":[{"gross_charge":4788.75,"discounted_cash":2394.38,"setting":"both","billing_class":"facility"}]},{"description":"PHENYLEPHRINE 1MG/10ML","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"0000102629","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J2372","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.04,"discounted_cash":18.52,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN 1000UN/ML 10ML","drug_information":{"unit":10000.0,"type":"UN"},"code_information":[{"code":"0000102652","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J1644","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":52.0,"setting":"both","billing_class":"facility"}]},{"description":"KETAMINE 1000MG/100ML IV","code_information":[{"code":"0000519002","type":"CDM"},{"code":"636","type":"RC"},{"code":"0J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.11,"discounted_cash":546.06,"setting":"both","billing_class":"facility"}]},{"description":"CDSM G1004","code_information":[{"code":"1","type":"CDM"},{"code":"320","type":"RC"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"MED/SURG 2 ISOLATION","code_information":[{"code":"10","type":"CDM"},{"code":"164","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1200.0,"setting":"both","billing_class":"facility"}]},{"description":"CATH NEPHRO LOOP","code_information":[{"code":"10002","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":277.5,"discounted_cash":138.75,"setting":"both","billing_class":"facility"}]},{"description":"CATH PACING BIPOLAR","code_information":[{"code":"10003","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.95,"discounted_cash":105.47,"setting":"both","billing_class":"facility"}]},{"description":"CATH PERITONEAL","code_information":[{"code":"10004","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":200.95,"discounted_cash":100.47,"setting":"both","billing_class":"facility"}]},{"description":"CATH RETENTION","code_information":[{"code":"10013","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.8,"discounted_cash":130.9,"setting":"both","billing_class":"facility"}]},{"description":"CATH ROYAL FLUSH","code_information":[{"code":"10015","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":670.35,"discounted_cash":335.18,"setting":"both","billing_class":"facility"}]},{"description":"CATH RUTNER WEDGE","code_information":[{"code":"10016","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":43.45,"discounted_cash":21.73,"setting":"both","billing_class":"facility"}]},{"description":"CATH SWAN GANZ","code_information":[{"code":"10028","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.35,"discounted_cash":69.17,"setting":"both","billing_class":"facility"}]},{"description":"CATH THORACIC","code_information":[{"code":"10035","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.15,"discounted_cash":12.07,"setting":"both","billing_class":"facility"}]},{"description":"CATH TRIPLE LUMEN","code_information":[{"code":"10036","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":149.0,"setting":"both","billing_class":"facility"}]},{"description":"CATH TROCAR","code_information":[{"code":"10037","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility"}]},{"description":"CATH UMBILICAL","code_information":[{"code":"10040","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":23.13,"setting":"both","billing_class":"facility"}]},{"description":"CATH URETERAL DISP","code_information":[{"code":"10042","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.05,"discounted_cash":20.52,"setting":"both","billing_class":"facility"}]},{"description":"CATH URETERAL WHISTL","code_information":[{"code":"10046","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.85,"discounted_cash":12.93,"setting":"both","billing_class":"facility"}]},{"description":"CATH URETHRAL COUNCI","code_information":[{"code":"10048","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.75,"discounted_cash":24.88,"setting":"both","billing_class":"facility"}]},{"description":"CATH UTERINE","code_information":[{"code":"10049","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1935.2,"discounted_cash":967.6,"setting":"both","billing_class":"facility"}]},{"description":"CAUTERY DISP","code_information":[{"code":"10052","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":105.3,"discounted_cash":52.65,"setting":"both","billing_class":"facility"}]},{"description":"CAUTERY EYE DISP","code_information":[{"code":"10053","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":136.7,"discounted_cash":68.35,"setting":"both","billing_class":"facility"}]},{"description":"CAUTERY LEEP DISP","code_information":[{"code":"10056","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility"}]},{"description":"CEMENT MIXER ARTISAN","code_information":[{"code":"10058","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":553.7,"discounted_cash":276.85,"setting":"both","billing_class":"facility"}]},{"description":"CLIP APPLIER","code_information":[{"code":"10075","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":311.65,"discounted_cash":155.82,"setting":"both","billing_class":"facility"}]},{"description":"CLIP APPLIER ENDO","code_information":[{"code":"10076","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":323.65,"discounted_cash":161.82,"setting":"both","billing_class":"facility"}]},{"description":"CLIP RANEY SCALP","code_information":[{"code":"10082","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.8,"discounted_cash":27.9,"setting":"both","billing_class":"facility"}]},{"description":"COLLAR CERVICAL","code_information":[{"code":"10089","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.75,"discounted_cash":13.88,"setting":"both","billing_class":"facility"}]},{"description":"COLLAR PHILI","code_information":[{"code":"10092","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":12.75,"setting":"both","billing_class":"facility"}]},{"description":"COLLECTOR SPECIMEN","code_information":[{"code":"10093","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"M/S 1 TELE PRIVATE","code_information":[{"code":"101","type":"CDM"},{"code":"206","type":"RC"},{"code":"G0379","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":2500.0,"discounted_cash":1250.0,"setting":"both","billing_class":"facility"}]},{"description":"CUFF TOURNIQUET STR","code_information":[{"code":"10104","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":55.55,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE INFLATION","code_information":[{"code":"10119","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":88.38,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE TORQUE","code_information":[{"code":"10121","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":112.85,"discounted_cash":56.42,"setting":"both","billing_class":"facility"}]},{"description":"BRIEF ADULT PK","code_information":[{"code":"10123","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.4,"discounted_cash":10.7,"setting":"both","billing_class":"facility"}]},{"description":"DIAPER BABY LRG/PK","code_information":[{"code":"10125","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.9,"discounted_cash":8.95,"setting":"both","billing_class":"facility"}]},{"description":"DIAPER BABY MED/PK","code_information":[{"code":"10126","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.3,"setting":"both","billing_class":"facility"}]},{"description":"DIAPER BABY XLRG/PK","code_information":[{"code":"10129","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.2,"discounted_cash":9.1,"setting":"both","billing_class":"facility"}]},{"description":"DILATOR ESOPHOGEAL","code_information":[{"code":"10131","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":333.25,"discounted_cash":166.63,"setting":"both","billing_class":"facility"}]},{"description":"DILATOR RENAL","code_information":[{"code":"10134","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":149.1,"discounted_cash":74.55,"setting":"both","billing_class":"facility"}]},{"description":"DILATOR VESSEL","code_information":[{"code":"10136","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.25,"discounted_cash":26.13,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN ABRAMSON","code_information":[{"code":"10138","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.6,"discounted_cash":43.3,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN BLAKE","code_information":[{"code":"10140","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.15,"discounted_cash":26.57,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN CHEST DOUBLE","code_information":[{"code":"10141","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.2,"discounted_cash":118.6,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN CHEST SINGLE","code_information":[{"code":"10144","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":127.5,"discounted_cash":63.75,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN JP FLAT","code_information":[{"code":"10147","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.65,"discounted_cash":10.32,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN JP ROUND","code_information":[{"code":"10148","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.05,"discounted_cash":8.53,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN SUMP SALEM","code_information":[{"code":"10154","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":13.32,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN T-TUBE","code_information":[{"code":"10157","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":15.25,"setting":"both","billing_class":"facility"}]},{"description":"DRAPE LASER","code_information":[{"code":"10191","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.65,"discounted_cash":36.83,"setting":"both","billing_class":"facility"}]},{"description":"DRILL BIT","code_information":[{"code":"10225","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":569.3,"discounted_cash":284.65,"setting":"both","billing_class":"facility"}]},{"description":"DRILL BIT","code_information":[{"code":"10226","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":212.5,"discounted_cash":106.25,"setting":"both","billing_class":"facility"}]},{"description":"DRILL BIT FLUTE","code_information":[{"code":"10227","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":782.95,"discounted_cash":391.48,"setting":"both","billing_class":"facility"}]},{"description":"DRILL BIT","code_information":[{"code":"10228","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility"}]},{"description":"DRILL BIT CALIBRATED","code_information":[{"code":"10229","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":660.75,"discounted_cash":330.38,"setting":"both","billing_class":"facility"}]},{"description":"DRILL BIT QUICK","code_information":[{"code":"10232","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":91.45,"discounted_cash":45.73,"setting":"both","billing_class":"facility"}]},{"description":"DSG ADAPTIC","code_information":[{"code":"10241","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":5.25,"setting":"both","billing_class":"facility"}]},{"description":"DRILL BIT CALIBRATED","code_information":[{"code":"10243","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":319.0,"setting":"both","billing_class":"facility"}]},{"description":"DSG ALGINATE <16SQIN","code_information":[{"code":"10246","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.8,"discounted_cash":16.4,"setting":"both","billing_class":"facility"}]},{"description":"DSG BIO PATCH","code_information":[{"code":"10257","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":13.25,"setting":"both","billing_class":"facility"}]},{"description":"DSG BURN","code_information":[{"code":"10263","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.95,"discounted_cash":16.98,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD ADMINISTRATION","code_information":[{"code":"103","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":935.38,"discounted_cash":467.69,"setting":"both","billing_class":"facility"}]},{"description":"DSG FIBRACEL","code_information":[{"code":"10307","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.1,"discounted_cash":117.55,"setting":"both","billing_class":"facility"}]},{"description":"DSG HYDROCOLLOID","code_information":[{"code":"10320","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":7.88,"setting":"both","billing_class":"facility"}]},{"description":"DSG HYDROGEL","code_information":[{"code":"10321","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":21.2,"setting":"both","billing_class":"facility"}]},{"description":"DSG INTERCEED 3 X 4","code_information":[{"code":"10323","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":737.25,"discounted_cash":368.63,"setting":"both","billing_class":"facility"}]},{"description":"DSG IODOFLEX GEL","code_information":[{"code":"10324","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.7,"discounted_cash":10.85,"setting":"both","billing_class":"facility"}]},{"description":"DSG KLING/CONFORM","code_information":[{"code":"10328","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.28,"setting":"both","billing_class":"facility"}]},{"description":"DSG MEPITEL","code_information":[{"code":"10330","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.65,"discounted_cash":10.32,"setting":"both","billing_class":"facility"}]},{"description":"DSG MEROCEL","code_information":[{"code":"10331","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.2,"discounted_cash":15.6,"setting":"both","billing_class":"facility"}]},{"description":"DSG TEGADERM 4 X 10","code_information":[{"code":"10361","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":2.63,"setting":"both","billing_class":"facility"}]},{"description":"DSG XEROFORM 5 X 9","code_information":[{"code":"10380","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":2.63,"setting":"both","billing_class":"facility"}]},{"description":"EAR WICK","code_information":[{"code":"10381","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":201.25,"discounted_cash":100.63,"setting":"both","billing_class":"facility"}]},{"description":"ELECTRODE ACOMIOPLAS","code_information":[{"code":"10385","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility"}]},{"description":"ELECTRODE ENT","code_information":[{"code":"10396","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":262.35,"discounted_cash":131.18,"setting":"both","billing_class":"facility"}]},{"description":"IMMUN ADMIN 1ST VACC","code_information":[{"code":"104","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.94,"discounted_cash":47.47,"setting":"both","billing_class":"facility"}]},{"description":"ELECTRODE PEDI","code_information":[{"code":"10418","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.95,"discounted_cash":9.97,"setting":"both","billing_class":"facility"}]},{"description":"ENDO CATCH BAG","code_information":[{"code":"10430","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.1,"discounted_cash":24.55,"setting":"both","billing_class":"facility"}]},{"description":"ENDO CLOSURE DEVICE","code_information":[{"code":"10431","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":510.35,"discounted_cash":255.18,"setting":"both","billing_class":"facility"}]},{"description":"ENDO GAUGE","code_information":[{"code":"10434","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.1,"discounted_cash":63.05,"setting":"both","billing_class":"facility"}]},{"description":"ENDO GRASPER","code_information":[{"code":"10435","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":258.05,"discounted_cash":129.03,"setting":"both","billing_class":"facility"}]},{"description":"ENDO RETRACTOR","code_information":[{"code":"10439","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":316.35,"discounted_cash":158.18,"setting":"both","billing_class":"facility"}]},{"description":"ENDO TISSUE TACKER","code_information":[{"code":"10454","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1427.65,"discounted_cash":713.83,"setting":"both","billing_class":"facility"}]},{"description":"EVACUATOR UROVAC","code_information":[{"code":"10457","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility"}]},{"description":"EXTRACTOR VACUUM","code_information":[{"code":"10459","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":93.5,"discounted_cash":46.75,"setting":"both","billing_class":"facility"}]},{"description":"FIBER LASER 200 MIC","code_information":[{"code":"10461","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":394.55,"discounted_cash":197.28,"setting":"both","billing_class":"facility"}]},{"description":"FIBER LASER 365/550","code_information":[{"code":"10462","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":526.0,"discounted_cash":263.0,"setting":"both","billing_class":"facility"}]},{"description":"FILTER KIDNEY STONE","code_information":[{"code":"10473","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"FORCEP BIOPSY DISP","code_information":[{"code":"10487","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.05,"discounted_cash":17.52,"setting":"both","billing_class":"facility"}]},{"description":"FORCEP GRASPING DISP","code_information":[{"code":"10489","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":385.65,"discounted_cash":192.82,"setting":"both","billing_class":"facility"}]},{"description":"FORCEP RADIAL JAW DI","code_information":[{"code":"10491","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":129.8,"discounted_cash":64.9,"setting":"both","billing_class":"facility"}]},{"description":"GLIDE CATH","code_information":[{"code":"10497","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":231.65,"discounted_cash":115.83,"setting":"both","billing_class":"facility"}]},{"description":"IMMUN ADMIN ADD VACC","code_information":[{"code":"105","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":44.31,"discounted_cash":22.16,"setting":"both","billing_class":"facility"}]},{"description":"GLOVE SURG BIOGEL","code_information":[{"code":"10502","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":1.95,"setting":"both","billing_class":"facility"}]},{"description":"GLOVE SURG MICRO TOU","code_information":[{"code":"10508","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"GLOVE SURG TRIFLEX","code_information":[{"code":"10514","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.35,"discounted_cash":3.67,"setting":"both","billing_class":"facility"}]},{"description":"GUIDE WIRE AMPLATZ","code_information":[{"code":"10525","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.75,"discounted_cash":47.88,"setting":"both","billing_class":"facility"}]},{"description":"GUIDE WIRE ANGIO","code_information":[{"code":"10526","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":491.05,"discounted_cash":245.53,"setting":"both","billing_class":"facility"}]},{"description":"GUIDE WIRE COOK","code_information":[{"code":"10528","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.6,"discounted_cash":26.8,"setting":"both","billing_class":"facility"}]},{"description":"GUIDE WIRE CYSTO","code_information":[{"code":"10529","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":68.75,"setting":"both","billing_class":"facility"}]},{"description":"GUIDE WIRE EXCHANGE","code_information":[{"code":"10532","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":306.25,"discounted_cash":153.13,"setting":"both","billing_class":"facility"}]},{"description":"GUIDE WIRE MAJIC TOU","code_information":[{"code":"10535","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":198.15,"discounted_cash":99.08,"setting":"both","billing_class":"facility"}]},{"description":"GUIDE WIRE NITENOL","code_information":[{"code":"10536","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":143.05,"discounted_cash":71.53,"setting":"both","billing_class":"facility"}]},{"description":"GUIDE WIRE ROSEN","code_information":[{"code":"10541","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.45,"discounted_cash":24.73,"setting":"both","billing_class":"facility"}]},{"description":"GUIDE WIRE SPRING","code_information":[{"code":"10543","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":19.63,"setting":"both","billing_class":"facility"}]},{"description":"GUIDE WIRE SS","code_information":[{"code":"10545","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":168.05,"discounted_cash":84.03,"setting":"both","billing_class":"facility"}]},{"description":"HEMOSTAT ABSORBABLE","code_information":[{"code":"10565","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":148.05,"discounted_cash":74.03,"setting":"both","billing_class":"facility"}]},{"description":"HEMOSTAT ABSORB 3X2","code_information":[{"code":"10566","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.35,"discounted_cash":48.17,"setting":"both","billing_class":"facility"}]},{"description":"FIBER LASER 1000 MIC","code_information":[{"code":"10567","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":982.15,"discounted_cash":491.07,"setting":"both","billing_class":"facility"}]},{"description":"FIBER LASER GRNLIGHT","code_information":[{"code":"10568","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2304.4,"discounted_cash":1152.2,"setting":"both","billing_class":"facility"}]},{"description":"IV BUTTERFLY","code_information":[{"code":"10577","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":6.05,"setting":"both","billing_class":"facility"}]},{"description":"IV INJECTION SITE","code_information":[{"code":"10579","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"IMMOB KNEE","code_information":[{"code":"10582","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.15,"discounted_cash":28.57,"setting":"both","billing_class":"facility"}]},{"description":"IMMOB SHOULDER","code_information":[{"code":"10584","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":28.05,"discounted_cash":14.03,"setting":"both","billing_class":"facility"}]},{"description":"IRRIGATOR ARTHRO-FLO","code_information":[{"code":"10591","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":55.0,"setting":"both","billing_class":"facility"}]},{"description":"K-WIRE","code_information":[{"code":"10596","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.9,"discounted_cash":17.95,"setting":"both","billing_class":"facility"}]},{"description":"K-WIRE TROCAR","code_information":[{"code":"10597","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.3,"setting":"both","billing_class":"facility"}]},{"description":"KIT ACL DISP","code_information":[{"code":"10598","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":470.05,"discounted_cash":235.03,"setting":"both","billing_class":"facility"}]},{"description":"IV INF HYDR INTL HR","code_information":[{"code":"106","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":294.1,"discounted_cash":147.05,"setting":"both","billing_class":"facility"}]},{"description":"KIT BIOP MONOPTY","code_information":[{"code":"10601","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":164.8,"discounted_cash":82.4,"setting":"both","billing_class":"facility"}]},{"description":"KIT EYE","code_information":[{"code":"10622","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.2,"discounted_cash":12.6,"setting":"both","billing_class":"facility"}]},{"description":"KIT FALLOPIAN RING","code_information":[{"code":"10624","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":247.5,"discounted_cash":123.75,"setting":"both","billing_class":"facility"}]},{"description":"KIT HIP BONE PREP","code_information":[{"code":"10627","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.5,"discounted_cash":75.75,"setting":"both","billing_class":"facility"}]},{"description":"KIT I.V. START","code_information":[{"code":"10629","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.05,"discounted_cash":11.03,"setting":"both","billing_class":"facility"}]},{"description":"KIT ORAL SUCTION","code_information":[{"code":"10646","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.45,"discounted_cash":11.72,"setting":"both","billing_class":"facility"}]},{"description":"KIT PNEUMOTHORAX","code_information":[{"code":"10653","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":318.9,"discounted_cash":159.45,"setting":"both","billing_class":"facility"}]},{"description":"KIT PRESSURE MONITOR","code_information":[{"code":"10656","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":20.88,"setting":"both","billing_class":"facility"}]},{"description":"KIT TISSEEL 10ML","code_information":[{"code":"10666","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1372.9,"discounted_cash":686.45,"setting":"both","billing_class":"facility"}]},{"description":"KIT TRANSDUCER","code_information":[{"code":"10690","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.8,"discounted_cash":16.9,"setting":"both","billing_class":"facility"}]},{"description":"LENS MORGAN EYE","code_information":[{"code":"10697","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.85,"discounted_cash":42.42,"setting":"both","billing_class":"facility"}]},{"description":"IV INF HYDR ADDL HR","code_information":[{"code":"107","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.3,"discounted_cash":26.65,"setting":"both","billing_class":"facility"}]},{"description":"MANIPULATOR UTERINE","code_information":[{"code":"10703","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":122.45,"discounted_cash":61.23,"setting":"both","billing_class":"facility"}]},{"description":"MASK ANES NEONATAL","code_information":[{"code":"10706","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.7,"discounted_cash":8.35,"setting":"both","billing_class":"facility"}]},{"description":"MATTRESS PORTA-WARM","code_information":[{"code":"10709","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.85,"discounted_cash":39.42,"setting":"both","billing_class":"facility"}]},{"description":"NDL BIOP BONE MARROW","code_information":[{"code":"10720","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":118.9,"discounted_cash":59.45,"setting":"both","billing_class":"facility"}]},{"description":"NDL BIOP SOFT TISSUE","code_information":[{"code":"10721","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":140.6,"discounted_cash":70.3,"setting":"both","billing_class":"facility"}]},{"description":"NDL BIOPSY TRU-CUT","code_information":[{"code":"10723","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":30.5,"setting":"both","billing_class":"facility"}]},{"description":"NDL CHIBA","code_information":[{"code":"10725","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":21.02,"setting":"both","billing_class":"facility"}]},{"description":"NDL PERCUFIX","code_information":[{"code":"10747","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":5.45,"setting":"both","billing_class":"facility"}]},{"description":"NDL PORT-A-CATH","code_information":[{"code":"10749","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":13.63,"setting":"both","billing_class":"facility"}]},{"description":"NDL RETROBULBAR","code_information":[{"code":"10750","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.1,"discounted_cash":8.55,"setting":"both","billing_class":"facility"}]},{"description":"NDL SPINAL","code_information":[{"code":"10755","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.3,"discounted_cash":32.65,"setting":"both","billing_class":"facility"}]},{"description":"NDL SPROTTLE","code_information":[{"code":"10756","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.45,"discounted_cash":24.23,"setting":"both","billing_class":"facility"}]},{"description":"NDL TOUHY","code_information":[{"code":"10758","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":35.75,"setting":"both","billing_class":"facility"}]},{"description":"NDL WANG","code_information":[{"code":"10760","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":172.2,"discounted_cash":86.1,"setting":"both","billing_class":"facility"}]},{"description":"NDL WHITACRE","code_information":[{"code":"10762","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.2,"discounted_cash":9.1,"setting":"both","billing_class":"facility"}]},{"description":"OST BELT","code_information":[{"code":"10770","type":"CDM"},{"code":"271","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":5.67,"setting":"both","billing_class":"facility"}]},{"description":"OST FLANGE","code_information":[{"code":"10776","type":"CDM"},{"code":"271","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.6,"discounted_cash":6.8,"setting":"both","billing_class":"facility"}]},{"description":"OST LOOP BRIDGE","code_information":[{"code":"10778","type":"CDM"},{"code":"271","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":2.55,"setting":"both","billing_class":"facility"}]},{"description":"OST PASTE","code_information":[{"code":"10779","type":"CDM"},{"code":"271","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.4,"discounted_cash":8.2,"setting":"both","billing_class":"facility"}]},{"description":"OST POUCH FECAL","code_information":[{"code":"10781","type":"CDM"},{"code":"271","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":8.88,"setting":"both","billing_class":"facility"}]},{"description":"OST POUCH OSTOMY","code_information":[{"code":"10782","type":"CDM"},{"code":"271","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":4.28,"setting":"both","billing_class":"facility"}]},{"description":"OST PWD KARAYA","code_information":[{"code":"10784","type":"CDM"},{"code":"271","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":6.25,"setting":"both","billing_class":"facility"}]},{"description":"PACEMAKER TRANSMT","code_information":[{"code":"10793","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1262.8,"discounted_cash":631.4,"setting":"both","billing_class":"facility"}]},{"description":"PACK ARTHROSCOPY","code_information":[{"code":"10796","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":185.55,"discounted_cash":92.78,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX 1 HR","code_information":[{"code":"108","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":294.1,"discounted_cash":147.05,"setting":"both","billing_class":"facility"}]},{"description":"PACK C-SECTION","code_information":[{"code":"10802","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":236.05,"discounted_cash":118.03,"setting":"both","billing_class":"facility"}]},{"description":"PACK CYSTO","code_information":[{"code":"10803","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.45,"discounted_cash":75.22,"setting":"both","billing_class":"facility"}]},{"description":"PACK DELIVERY VAG","code_information":[{"code":"10808","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.8,"discounted_cash":38.9,"setting":"both","billing_class":"facility"}]},{"description":"PACK ENT","code_information":[{"code":"10812","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.2,"discounted_cash":55.6,"setting":"both","billing_class":"facility"}]},{"description":"PACK EYE","code_information":[{"code":"10815","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":200.6,"discounted_cash":100.3,"setting":"both","billing_class":"facility"}]},{"description":"PACK HEARING SCREEN","code_information":[{"code":"10819","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":185.85,"discounted_cash":92.92,"setting":"both","billing_class":"facility"}]},{"description":"PACK HIP","code_information":[{"code":"10821","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":858.25,"discounted_cash":429.13,"setting":"both","billing_class":"facility"}]},{"description":"PACK ISOLATION","code_information":[{"code":"10826","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.85,"discounted_cash":41.92,"setting":"both","billing_class":"facility"}]},{"description":"PACK JOINT TOTAL","code_information":[{"code":"10828","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":766.35,"discounted_cash":383.18,"setting":"both","billing_class":"facility"}]},{"description":"PACK LAP CHOLE","code_information":[{"code":"10830","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":539.1,"discounted_cash":269.55,"setting":"both","billing_class":"facility"}]},{"description":"PACK LITHOTOMY","code_information":[{"code":"10832","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.1,"discounted_cash":18.05,"setting":"both","billing_class":"facility"}]},{"description":"PACK MAJOR","code_information":[{"code":"10833","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.85,"discounted_cash":75.92,"setting":"both","billing_class":"facility"}]},{"description":"PACK MINOR","code_information":[{"code":"10835","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":97.1,"discounted_cash":48.55,"setting":"both","billing_class":"facility"}]},{"description":"PACK OB","code_information":[{"code":"10837","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":220.3,"discounted_cash":110.15,"setting":"both","billing_class":"facility"}]},{"description":"PACK ORTHO","code_information":[{"code":"10838","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":169.75,"discounted_cash":84.88,"setting":"both","billing_class":"facility"}]},{"description":"PACK PEDIATRIC","code_information":[{"code":"10840","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":12.63,"setting":"both","billing_class":"facility"}]},{"description":"PACK RADIOLOGY SAN","code_information":[{"code":"10844","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":177.1,"discounted_cash":88.55,"setting":"both","billing_class":"facility"}]},{"description":"PACK SHOULDER ORTHO","code_information":[{"code":"10845","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":309.25,"discounted_cash":154.63,"setting":"both","billing_class":"facility"}]},{"description":"PACK VASCULAR","code_information":[{"code":"10849","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":466.15,"discounted_cash":233.07,"setting":"both","billing_class":"facility"}]},{"description":"PILLOW ABDUCTION","code_information":[{"code":"10853","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":245.6,"discounted_cash":122.8,"setting":"both","billing_class":"facility"}]},{"description":"PAD CRYO THERAPY","code_information":[{"code":"10856","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":406.85,"discounted_cash":203.43,"setting":"both","billing_class":"facility"}]},{"description":"PAD GROUNDING ADULT","code_information":[{"code":"10861","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":5.08,"setting":"both","billing_class":"facility"}]},{"description":"PASSER SUTURE","code_information":[{"code":"10871","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":374.25,"discounted_cash":187.13,"setting":"both","billing_class":"facility"}]},{"description":"PENCIL BOVIE","code_information":[{"code":"10874","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.95,"discounted_cash":5.97,"setting":"both","billing_class":"facility"}]},{"description":"PENCIL CAUTERY WETFI","code_information":[{"code":"10876","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":134.3,"discounted_cash":67.15,"setting":"both","billing_class":"facility"}]},{"description":"PENCIL FOOT CONTROL","code_information":[{"code":"10877","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.45,"discounted_cash":4.72,"setting":"both","billing_class":"facility"}]},{"description":"PENCIL HANDSWITCH","code_information":[{"code":"10878","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":157.65,"discounted_cash":78.83,"setting":"both","billing_class":"facility"}]},{"description":"PLEDGETT","code_information":[{"code":"10887","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":39.95,"discounted_cash":19.98,"setting":"both","billing_class":"facility"}]},{"description":"STPL LINEAR","code_information":[{"code":"10895","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":420.9,"discounted_cash":210.45,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX ADDL HR","code_information":[{"code":"109","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility"}]},{"description":"PROBE BLUNT","code_information":[{"code":"10904","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.45,"discounted_cash":65.22,"setting":"both","billing_class":"facility"}]},{"description":"PROBE COVER STERILE","code_information":[{"code":"10908","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.9,"discounted_cash":32.95,"setting":"both","billing_class":"facility"}]},{"description":"PROBE ERCP GOLD","code_information":[{"code":"10909","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":518.5,"discounted_cash":259.25,"setting":"both","billing_class":"facility"}]},{"description":"PROBE ESOPHO/RECTAL","code_information":[{"code":"10912","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.8,"discounted_cash":13.9,"setting":"both","billing_class":"facility"}]},{"description":"PROBE EYE","code_information":[{"code":"10913","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.2,"discounted_cash":177.1,"setting":"both","billing_class":"facility"}]},{"description":"PROBE LITHOTRIP","code_information":[{"code":"10920","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":678.7,"discounted_cash":339.35,"setting":"both","billing_class":"facility"}]},{"description":"PROBE MAMOTOME","code_information":[{"code":"10921","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":729.6,"discounted_cash":364.8,"setting":"both","billing_class":"facility"}]},{"description":"PROTECTOR EYE CORNEA","code_information":[{"code":"10928","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":40.3,"discounted_cash":20.15,"setting":"both","billing_class":"facility"}]},{"description":"RETRACTOR DISP","code_information":[{"code":"10943","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.8,"discounted_cash":168.4,"setting":"both","billing_class":"facility"}]},{"description":"RETRACTOR FISH","code_information":[{"code":"10945","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.1,"discounted_cash":37.55,"setting":"both","billing_class":"facility"}]},{"description":"RETRACTOR IRIS","code_information":[{"code":"10946","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":201.65,"discounted_cash":100.83,"setting":"both","billing_class":"facility"}]},{"description":"SCISSOR LAP","code_information":[{"code":"10965","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.5,"discounted_cash":75.75,"setting":"both","billing_class":"facility"}]},{"description":"SET ARTHROSCOPE","code_information":[{"code":"10976","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":180.65,"discounted_cash":90.33,"setting":"both","billing_class":"facility"}]},{"description":"SET CERVICAL BIOPSY","code_information":[{"code":"10981","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":134.7,"discounted_cash":67.35,"setting":"both","billing_class":"facility"}]},{"description":"SET COLON DECOMPRESS","code_information":[{"code":"10982","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.45,"discounted_cash":218.72,"setting":"both","billing_class":"facility"}]},{"description":"SET EPIDURAL EXT","code_information":[{"code":"10985","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.45,"discounted_cash":14.72,"setting":"both","billing_class":"facility"}]},{"description":"SET EXTENSION HI FLO","code_information":[{"code":"10988","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.8,"discounted_cash":4.9,"setting":"both","billing_class":"facility"}]},{"description":"SET EXTENSION W/FILT","code_information":[{"code":"10990","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":8.25,"setting":"both","billing_class":"facility"}]},{"description":"SET INSERT FOGARTY","code_information":[{"code":"10998","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":68.4,"discounted_cash":34.2,"setting":"both","billing_class":"facility"}]},{"description":"M/S 2 OBS 1ST HR","code_information":[{"code":"11","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":620.0,"discounted_cash":310.0,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX SEQ 1HR","code_information":[{"code":"110","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":166.1,"discounted_cash":83.05,"setting":"both","billing_class":"facility"}]},{"description":"SET NEPHROSTOMY","code_information":[{"code":"11012","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":290.45,"discounted_cash":145.22,"setting":"both","billing_class":"facility"}]},{"description":"SET PNEUMO","code_information":[{"code":"11015","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":333.6,"discounted_cash":166.8,"setting":"both","billing_class":"facility"}]},{"description":"SET SUTURE ARTHREX","code_information":[{"code":"11023","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":454.25,"discounted_cash":227.13,"setting":"both","billing_class":"facility"}]},{"description":"SHIELD BREAST SMALL","code_information":[{"code":"11027","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":28.35,"discounted_cash":14.18,"setting":"both","billing_class":"facility"}]},{"description":"SHEAR HARMONIC","code_information":[{"code":"11028","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1052.15,"discounted_cash":526.08,"setting":"both","billing_class":"facility"}]},{"description":"SHIELD BREAST/NIPPLE","code_information":[{"code":"11032","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":56.05,"discounted_cash":28.02,"setting":"both","billing_class":"facility"}]},{"description":"SHIELD EYE BILI","code_information":[{"code":"11034","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":1.75,"setting":"both","billing_class":"facility"}]},{"description":"SHOE CAST","code_information":[{"code":"11038","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility"}]},{"description":"SHOE POST-OP","code_information":[{"code":"11040","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.4,"discounted_cash":7.7,"setting":"both","billing_class":"facility"}]},{"description":"SHUNT CAROTID ARTERY","code_information":[{"code":"11044","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1396.1,"discounted_cash":698.05,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVE ARTHREX SHOUL","code_information":[{"code":"11045","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":441.25,"discounted_cash":220.63,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVE KNEE COMPRESS","code_information":[{"code":"11048","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":122.45,"discounted_cash":61.23,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVE THIGH COMPRES","code_information":[{"code":"11052","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.45,"discounted_cash":75.22,"setting":"both","billing_class":"facility"}]},{"description":"SLING & SWATHE","code_information":[{"code":"11053","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility"}]},{"description":"SLING ARM","code_information":[{"code":"11054","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":5.45,"setting":"both","billing_class":"facility"}]},{"description":"SLING SHOULDER","code_information":[{"code":"11056","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":153.25,"discounted_cash":76.63,"setting":"both","billing_class":"facility"}]},{"description":"SNARE COLONOSCOPY","code_information":[{"code":"11057","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":39.25,"setting":"both","billing_class":"facility"}]},{"description":"SNARE POLYPECTOMY DI","code_information":[{"code":"11059","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.7,"discounted_cash":30.85,"setting":"both","billing_class":"facility"}]},{"description":"SNARE RETRIVAL","code_information":[{"code":"11060","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":412.5,"setting":"both","billing_class":"facility"}]},{"description":"SOLN ACETIC ACID IRR","code_information":[{"code":"11064","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":15.15,"setting":"both","billing_class":"facility"}]},{"description":"SOLN H20 IRRI 3L BG","code_information":[{"code":"11071","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":9.63,"setting":"both","billing_class":"facility"}]},{"description":"SOLN H20 IRRI 500 BT","code_information":[{"code":"11072","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility"}]},{"description":"SOLN NS IRRI 1L BTL","code_information":[{"code":"11073","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.3,"discounted_cash":6.65,"setting":"both","billing_class":"facility"}]},{"description":"SOLN NS IRRI 500 BTL","code_information":[{"code":"11076","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.7,"discounted_cash":6.35,"setting":"both","billing_class":"facility"}]},{"description":"SPACER MDI","code_information":[{"code":"11081","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":12.5,"setting":"both","billing_class":"facility"}]},{"description":"LARYNGOSCOPE DISP","code_information":[{"code":"11084","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.65,"discounted_cash":39.33,"setting":"both","billing_class":"facility"}]},{"description":"SPLINT AIR ANKLE","code_information":[{"code":"11090","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.75,"discounted_cash":38.38,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX CONCRNT","code_information":[{"code":"111","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.15,"discounted_cash":47.58,"setting":"both","billing_class":"facility"}]},{"description":"SPLINT FOREARM","code_information":[{"code":"11105","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":12.63,"setting":"both","billing_class":"facility"}]},{"description":"SPLINT NASAL KENNEDY","code_information":[{"code":"11114","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.3,"discounted_cash":33.15,"setting":"both","billing_class":"facility"}]},{"description":"SPLINT THUMB","code_information":[{"code":"11118","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.85,"discounted_cash":41.92,"setting":"both","billing_class":"facility"}]},{"description":"SPONGE PEANUT","code_information":[{"code":"11128","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.15,"discounted_cash":2.58,"setting":"both","billing_class":"facility"}]},{"description":"SPONGE TONSIL MD","code_information":[{"code":"11133","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":2.25,"setting":"both","billing_class":"facility"}]},{"description":"STENT PIGTAIL","code_information":[{"code":"11145","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":217.45,"discounted_cash":108.72,"setting":"both","billing_class":"facility"}]},{"description":"STENT SINUS","code_information":[{"code":"11146","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":241.65,"discounted_cash":120.83,"setting":"both","billing_class":"facility"}]},{"description":"STENT URETERAL","code_information":[{"code":"11148","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":282.4,"discounted_cash":141.2,"setting":"both","billing_class":"facility"}]},{"description":"STENT URETHERAL","code_information":[{"code":"11149","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.3,"discounted_cash":221.65,"setting":"both","billing_class":"facility"}]},{"description":"STIMULATOR NERVE","code_information":[{"code":"11153","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":181.35,"discounted_cash":90.67,"setting":"both","billing_class":"facility"}]},{"description":"STPL ENDO GIA","code_information":[{"code":"11171","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":882.45,"discounted_cash":441.23,"setting":"both","billing_class":"facility"}]},{"description":"STPL PURSE STRING","code_information":[{"code":"11175","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":670.65,"discounted_cash":335.32,"setting":"both","billing_class":"facility"}]},{"description":"STPL ROTICULATOR","code_information":[{"code":"11176","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":613.45,"discounted_cash":306.73,"setting":"both","billing_class":"facility"}]},{"description":"STPL ENDO GIA VASC","code_information":[{"code":"11186","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":319.55,"discounted_cash":159.78,"setting":"both","billing_class":"facility"}]},{"description":"STPL PROXIMATE DLU","code_information":[{"code":"11194","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":307.65,"discounted_cash":153.82,"setting":"both","billing_class":"facility"}]},{"description":"STPL SKIN","code_information":[{"code":"11196","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.05,"discounted_cash":15.03,"setting":"both","billing_class":"facility"}]},{"description":"INJ IM/SQ","code_information":[{"code":"112","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":53.88,"setting":"both","billing_class":"facility"}]},{"description":"STPL CUTTER DLU","code_information":[{"code":"11201","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":561.2,"discounted_cash":280.6,"setting":"both","billing_class":"facility"}]},{"description":"SUCTION TRACH CLOSED","code_information":[{"code":"11221","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.35,"discounted_cash":13.18,"setting":"both","billing_class":"facility"}]},{"description":"BRA SURGICAL ZIP SML","code_information":[{"code":"11227","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":134.1,"discounted_cash":67.05,"setting":"both","billing_class":"facility"}]},{"description":"SUPPORT HELY PATELLA","code_information":[{"code":"11228","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.9,"discounted_cash":36.45,"setting":"both","billing_class":"facility"}]},{"description":"SUPPORT PATELLA","code_information":[{"code":"11230","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.9,"discounted_cash":36.45,"setting":"both","billing_class":"facility"}]},{"description":"SUT ENDO CARTRIDGE","code_information":[{"code":"11237","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":187.65,"discounted_cash":93.83,"setting":"both","billing_class":"facility"}]},{"description":"SUT RETRIEVER","code_information":[{"code":"11238","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":203.4,"discounted_cash":101.7,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP A","code_information":[{"code":"11239","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.05,"discounted_cash":7.03,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP B","code_information":[{"code":"11240","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.3,"discounted_cash":8.65,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP C","code_information":[{"code":"11241","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.95,"discounted_cash":10.97,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP D","code_information":[{"code":"11242","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP E","code_information":[{"code":"11243","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.2,"discounted_cash":18.1,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP F","code_information":[{"code":"11244","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.6,"discounted_cash":20.8,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP G","code_information":[{"code":"11245","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.6,"discounted_cash":26.8,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP H","code_information":[{"code":"11246","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.4,"discounted_cash":30.2,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP I","code_information":[{"code":"11247","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.15,"discounted_cash":35.08,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP J","code_information":[{"code":"11248","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.4,"discounted_cash":38.2,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP K","code_information":[{"code":"11249","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":40.13,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP L","code_information":[{"code":"11250","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.6,"discounted_cash":40.3,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP N","code_information":[{"code":"11252","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":98.5,"discounted_cash":49.25,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP O","code_information":[{"code":"11253","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.5,"discounted_cash":58.25,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP P","code_information":[{"code":"11254","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.4,"discounted_cash":58.2,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP Q","code_information":[{"code":"11255","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.2,"discounted_cash":63.1,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP T","code_information":[{"code":"11258","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.45,"discounted_cash":75.22,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP U","code_information":[{"code":"11259","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":172.1,"discounted_cash":86.05,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP V","code_information":[{"code":"11260","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":206.55,"discounted_cash":103.28,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP Y","code_information":[{"code":"11263","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":283.7,"discounted_cash":141.85,"setting":"both","billing_class":"facility"}]},{"description":"SUT GROUP Z","code_information":[{"code":"11264","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":453.85,"discounted_cash":226.93,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM IVC FEMORAL","code_information":[{"code":"11276","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2430.75,"discounted_cash":1215.38,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM IVC JUGULAR","code_information":[{"code":"11277","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2413.55,"discounted_cash":1206.78,"setting":"both","billing_class":"facility"}]},{"description":"TIP VACURETTE TAB","code_information":[{"code":"11289","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.8,"discounted_cash":11.4,"setting":"both","billing_class":"facility"}]},{"description":"EXPANDER TISSUE","code_information":[{"code":"11290","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3304.25,"discounted_cash":1652.13,"setting":"both","billing_class":"facility"}]},{"description":"TRAC BOOT BUCKS","code_information":[{"code":"11294","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":74.35,"discounted_cash":37.17,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP SGL/INT SUBS","code_information":[{"code":"113","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":278.95,"discounted_cash":139.47,"setting":"both","billing_class":"facility"}]},{"description":"TRAY AMNIOCENTESIS","code_information":[{"code":"11318","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.2,"discounted_cash":19.1,"setting":"both","billing_class":"facility"}]},{"description":"TRAY BIOPSY","code_information":[{"code":"11322","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":98.15,"discounted_cash":49.08,"setting":"both","billing_class":"facility"}]},{"description":"TRAY BIOPSY CT","code_information":[{"code":"11323","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.3,"discounted_cash":20.65,"setting":"both","billing_class":"facility"}]},{"description":"TRAY BONE MARROW W/N","code_information":[{"code":"11325","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":169.75,"discounted_cash":84.88,"setting":"both","billing_class":"facility"}]},{"description":"TRAY CATH FOLEY","code_information":[{"code":"11331","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.4,"discounted_cash":38.7,"setting":"both","billing_class":"facility"}]},{"description":"TRAY CATH INTRODUCER","code_information":[{"code":"11332","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":239.2,"discounted_cash":119.6,"setting":"both","billing_class":"facility"}]},{"description":"TRAY CATH URETHRAL","code_information":[{"code":"11333","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":7.88,"setting":"both","billing_class":"facility"}]},{"description":"TRAY CATH W/O FOLEY","code_information":[{"code":"11334","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.85,"discounted_cash":19.43,"setting":"both","billing_class":"facility"}]},{"description":"TRAY DRESSING CHANGE","code_information":[{"code":"11340","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":6.47,"setting":"both","billing_class":"facility"}]},{"description":"TRAY EPIDURAL","code_information":[{"code":"11342","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.7,"discounted_cash":17.85,"setting":"both","billing_class":"facility"}]},{"description":"TRAY INTRODUCER COBE","code_information":[{"code":"11353","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":161.65,"discounted_cash":80.83,"setting":"both","billing_class":"facility"}]},{"description":"TRAY LUMBAR ADULT","code_information":[{"code":"11361","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.15,"discounted_cash":30.57,"setting":"both","billing_class":"facility"}]},{"description":"TRAY LUMBAR PEDI","code_information":[{"code":"11363","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.35,"discounted_cash":27.18,"setting":"both","billing_class":"facility"}]},{"description":"TRAY PERCUTANEOUS CA","code_information":[{"code":"11372","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":197.75,"discounted_cash":98.88,"setting":"both","billing_class":"facility"}]},{"description":"TRAY PICC LINE","code_information":[{"code":"11375","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":392.05,"discounted_cash":196.03,"setting":"both","billing_class":"facility"}]},{"description":"TRAY SPINAL","code_information":[{"code":"11385","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.5,"discounted_cash":32.75,"setting":"both","billing_class":"facility"}]},{"description":"TRAY THORACENTESIS","code_information":[{"code":"11388","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":152.25,"discounted_cash":76.13,"setting":"both","billing_class":"facility"}]},{"description":"TRAY URINE METER","code_information":[{"code":"11393","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":136.75,"discounted_cash":68.38,"setting":"both","billing_class":"facility"}]},{"description":"TRAY UROLOGICAL","code_information":[{"code":"11394","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.25,"discounted_cash":234.13,"setting":"both","billing_class":"facility"}]},{"description":"TROCAR 10MM","code_information":[{"code":"11399","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":754.55,"discounted_cash":377.27,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP ADD/SEQ SUBS","code_information":[{"code":"114","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.5,"discounted_cash":79.25,"setting":"both","billing_class":"facility"}]},{"description":"TROCAR 12MM","code_information":[{"code":"11400","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.7,"discounted_cash":105.35,"setting":"both","billing_class":"facility"}]},{"description":"TROCAR 5MM","code_information":[{"code":"11401","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":175.55,"discounted_cash":87.78,"setting":"both","billing_class":"facility"}]},{"description":"TUBE ENDO BRONCH","code_information":[{"code":"11418","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.45,"discounted_cash":396.23,"setting":"both","billing_class":"facility"}]},{"description":"TUBE ET CUFFED","code_information":[{"code":"11419","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.1,"setting":"both","billing_class":"facility"}]},{"description":"TUBE ET LAZER","code_information":[{"code":"11421","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":371.8,"discounted_cash":185.9,"setting":"both","billing_class":"facility"}]},{"description":"TUBE ET UNCUFF","code_information":[{"code":"11423","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":2.33,"setting":"both","billing_class":"facility"}]},{"description":"TUBE FEEDING","code_information":[{"code":"11425","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.25,"discounted_cash":113.63,"setting":"both","billing_class":"facility"}]},{"description":"TUBE FEEDING DOBHOFF","code_information":[{"code":"11426","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":28.65,"discounted_cash":14.32,"setting":"both","billing_class":"facility"}]},{"description":"TUBE GASTRO","code_information":[{"code":"11429","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":127.4,"discounted_cash":63.7,"setting":"both","billing_class":"facility"}]},{"description":"TUBE J-JUNOSTOMY","code_information":[{"code":"11432","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":371.9,"discounted_cash":185.95,"setting":"both","billing_class":"facility"}]},{"description":"TUBE NASAL RAE","code_information":[{"code":"11437","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.65,"discounted_cash":10.82,"setting":"both","billing_class":"facility"}]},{"description":"TUBE SHILEY","code_information":[{"code":"11440","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":177.1,"discounted_cash":88.55,"setting":"both","billing_class":"facility"}]},{"description":"TUBE TRACH","code_information":[{"code":"11444","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":217.8,"discounted_cash":108.9,"setting":"both","billing_class":"facility"}]},{"description":"TUBING EXTENSION CT","code_information":[{"code":"11458","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.85,"setting":"both","billing_class":"facility"}]},{"description":"TUBING FLUID WARM","code_information":[{"code":"11459","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.75,"discounted_cash":24.88,"setting":"both","billing_class":"facility"}]},{"description":"TUBING IRRIG ORTHO","code_information":[{"code":"11462","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.45,"discounted_cash":52.23,"setting":"both","billing_class":"facility"}]},{"description":"TUBING SAMPLE","code_information":[{"code":"11476","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.8,"discounted_cash":38.9,"setting":"both","billing_class":"facility"}]},{"description":"TUNNELER DISP","code_information":[{"code":"11484","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":182.35,"discounted_cash":91.17,"setting":"both","billing_class":"facility"}]},{"description":"UNDERPAD DISP PACK","code_information":[{"code":"11486","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.85,"discounted_cash":31.93,"setting":"both","billing_class":"facility"}]},{"description":"VALVE BIOPSY","code_information":[{"code":"11489","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":119.9,"discounted_cash":59.95,"setting":"both","billing_class":"facility"}]},{"description":"VALVE HEIMLICH","code_information":[{"code":"11491","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":110.5,"setting":"both","billing_class":"facility"}]},{"description":"VALVEULATOME DISP","code_information":[{"code":"11498","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2760.2,"discounted_cash":1380.1,"setting":"both","billing_class":"facility"}]},{"description":"STRIPPER VEIN","code_information":[{"code":"11499","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":105.25,"discounted_cash":52.63,"setting":"both","billing_class":"facility"}]},{"description":"ADMIN INFLUENZA VACC","code_information":[{"code":"115","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.84,"discounted_cash":36.42,"setting":"both","billing_class":"facility"}]},{"description":"WIRE INTRODUCER","code_information":[{"code":"11508","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":163.8,"discounted_cash":81.9,"setting":"both","billing_class":"facility"}]},{"description":"TROCAR 8MM","code_information":[{"code":"11517","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":185.3,"discounted_cash":92.65,"setting":"both","billing_class":"facility"}]},{"description":"CATH ARTERY RADIAL","code_information":[{"code":"11518","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":71.75,"discounted_cash":35.88,"setting":"both","billing_class":"facility"}]},{"description":"PACK CATH LAB","code_information":[{"code":"11519","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":132.95,"discounted_cash":66.47,"setting":"both","billing_class":"facility"}]},{"description":"HEMOCLIP","code_information":[{"code":"11520","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.15,"discounted_cash":20.57,"setting":"both","billing_class":"facility"}]},{"description":"CUTTER VASCULAR","code_information":[{"code":"11523","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3082.85,"discounted_cash":1541.42,"setting":"both","billing_class":"facility"}]},{"description":"APPLIER MENISICAL","code_information":[{"code":"11526","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":528.2,"discounted_cash":264.1,"setting":"both","billing_class":"facility"}]},{"description":"NDL INTERSTIM","code_information":[{"code":"11539","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":145.9,"discounted_cash":72.95,"setting":"both","billing_class":"facility"}]},{"description":"ANTENNA INTERSTIM","code_information":[{"code":"11540","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":269.1,"discounted_cash":134.55,"setting":"both","billing_class":"facility"}]},{"description":"INTRODUCER T","code_information":[{"code":"11541","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.55,"discounted_cash":19.27,"setting":"both","billing_class":"facility"}]},{"description":"DSG ACCESS SITE VASC","code_information":[{"code":"11542","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":153.25,"discounted_cash":76.63,"setting":"both","billing_class":"facility"}]},{"description":"SUPPORT ELBOW","code_information":[{"code":"11546","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.8,"discounted_cash":11.4,"setting":"both","billing_class":"facility"}]},{"description":"GUIDE WIRE J WIRE","code_information":[{"code":"11550","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.8,"discounted_cash":35.4,"setting":"both","billing_class":"facility"}]},{"description":"HANDLE SUCTION","code_information":[{"code":"11551","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":44.55,"discounted_cash":22.27,"setting":"both","billing_class":"facility"}]},{"description":"SYSTM PAIN MGT 100","code_information":[{"code":"11552","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":324.1,"discounted_cash":162.05,"setting":"both","billing_class":"facility"}]},{"description":"SET FEEDING","code_information":[{"code":"11553","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.45,"discounted_cash":4.72,"setting":"both","billing_class":"facility"}]},{"description":"BLADE SAW DIAMOND","code_information":[{"code":"11555","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.15,"discounted_cash":202.57,"setting":"both","billing_class":"facility"}]},{"description":"TRAY SPINAL/EPIDURAL","code_information":[{"code":"11558","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.35,"discounted_cash":26.68,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA RF NDL","code_information":[{"code":"11559","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.6,"discounted_cash":33.3,"setting":"both","billing_class":"facility"}]},{"description":"KIT NDL W/THRD CANN","code_information":[{"code":"11560","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":304.15,"discounted_cash":152.07,"setting":"both","billing_class":"facility"}]},{"description":"KIT BIOPSY ACCESSORY","code_information":[{"code":"11561","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":194.5,"setting":"both","billing_class":"facility"}]},{"description":"ELECTRODE WAND RF","code_information":[{"code":"11562","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.05,"discounted_cash":701.52,"setting":"both","billing_class":"facility"}]},{"description":"ELECTRODE RF DISP","code_information":[{"code":"11563","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.8,"discounted_cash":168.4,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN MULTIPURPOSE","code_information":[{"code":"11564","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.35,"discounted_cash":117.67,"setting":"both","billing_class":"facility"}]},{"description":"CATH COIL DELIVERY","code_information":[{"code":"11565","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1323.1,"discounted_cash":661.55,"setting":"both","billing_class":"facility"}]},{"description":"KIT PTD","code_information":[{"code":"11566","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1394.7,"discounted_cash":697.35,"setting":"both","billing_class":"facility"}]},{"description":"KIT PROCEDURE EVLT","code_information":[{"code":"11567","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1225.55,"discounted_cash":612.77,"setting":"both","billing_class":"facility"}]},{"description":"KIT INTRODUCER PEG","code_information":[{"code":"11568","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":605.35,"discounted_cash":302.68,"setting":"both","billing_class":"facility"}]},{"description":"TUBING INFILTRATION","code_information":[{"code":"11569","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":68.4,"discounted_cash":34.2,"setting":"both","billing_class":"facility"}]},{"description":"SET NDL VERTEBRAL BX","code_information":[{"code":"11570","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":766.1,"discounted_cash":383.05,"setting":"both","billing_class":"facility"}]},{"description":"KIT VERTEBRL AUGMENT","code_information":[{"code":"11571","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3812.15,"discounted_cash":1906.08,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING RDC","code_information":[{"code":"11572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":355.56,"discounted_cash":177.78,"setting":"both","billing_class":"facility"}]},{"description":"GUIDE WIRE VIPER","code_information":[{"code":"11573","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":586.45,"discounted_cash":293.23,"setting":"both","billing_class":"facility"}]},{"description":"CARTRIDGE NITROUS OX","code_information":[{"code":"11574","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":185.2,"discounted_cash":92.6,"setting":"both","billing_class":"facility"}]},{"description":"LUBE ATHERECTOMY DVC","code_information":[{"code":"11575","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.1,"discounted_cash":151.55,"setting":"both","billing_class":"facility"}]},{"description":"KIT CATH DIALYSIS","code_information":[{"code":"11576","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":644.58,"setting":"both","billing_class":"facility"}]},{"description":"CATH PERIPHERAL SUPP","code_information":[{"code":"11577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":538.75,"discounted_cash":269.38,"setting":"both","billing_class":"facility"}]},{"description":"CATH EXTRACTION","code_information":[{"code":"11578","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2197.55,"discounted_cash":1098.78,"setting":"both","billing_class":"facility"}]},{"description":"CATH DILATION PDS","code_information":[{"code":"11579","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1598.4,"discounted_cash":799.2,"setting":"both","billing_class":"facility"}]},{"description":"CATH THROMBOLYSIS","code_information":[{"code":"11580","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":4409.2,"discounted_cash":2204.6,"setting":"both","billing_class":"facility"}]},{"description":"CATH CTO CROSSER OTW","code_information":[{"code":"11581","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3693.55,"discounted_cash":1846.78,"setting":"both","billing_class":"facility"}]},{"description":"SUIT BILI THERAPY","code_information":[{"code":"11582","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":39.95,"discounted_cash":19.98,"setting":"both","billing_class":"facility"}]},{"description":"DSG PURACOL + AG 2X2","code_information":[{"code":"11584","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.1,"discounted_cash":24.55,"setting":"both","billing_class":"facility"}]},{"description":"TRAY VENOUS ACCESS","code_information":[{"code":"11585","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":167.25,"discounted_cash":83.63,"setting":"both","billing_class":"facility"}]},{"description":"DSG CHIFFON STERILE","code_information":[{"code":"11586","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.8,"discounted_cash":28.9,"setting":"both","billing_class":"facility"}]},{"description":"APPLIGRAF PER SQ CM","code_information":[{"code":"11587","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4101","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":85.49,"discounted_cash":42.74,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE WND LARVE","code_information":[{"code":"11590","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":329.65,"discounted_cash":164.82,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE BX CORE DISP","code_information":[{"code":"11591","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":206.05,"discounted_cash":103.03,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE BX GUIDE","code_information":[{"code":"11592","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":32.25,"setting":"both","billing_class":"facility"}]},{"description":"DSG TEGADERM 5X6","code_information":[{"code":"11593","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.35,"discounted_cash":13.18,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE ENDARECTOMY","code_information":[{"code":"11597","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3745.8,"discounted_cash":1872.9,"setting":"both","billing_class":"facility"}]},{"description":"DISSECTOR BLUNT","code_information":[{"code":"11598","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2861.95,"discounted_cash":1430.97,"setting":"both","billing_class":"facility"}]},{"description":"NDL MENISCAL CURVED","code_information":[{"code":"11599","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":768.8,"discounted_cash":384.4,"setting":"both","billing_class":"facility"}]},{"description":"ADMIN PNEUMO VACC","code_information":[{"code":"116","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.46,"discounted_cash":36.73,"setting":"both","billing_class":"facility"}]},{"description":"DSG MEPILEX 3X4","code_information":[{"code":"11601","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.65,"discounted_cash":16.82,"setting":"both","billing_class":"facility"}]},{"description":"CATH DIALYSIS","code_information":[{"code":"11602","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":373.05,"discounted_cash":186.53,"setting":"both","billing_class":"facility"}]},{"description":"DSG SILVERCELL 4 X 4","code_information":[{"code":"11603","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":20.63,"setting":"both","billing_class":"facility"}]},{"description":"DSG SILVERCELL 1X12","code_information":[{"code":"11604","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.7,"discounted_cash":17.85,"setting":"both","billing_class":"facility"}]},{"description":"DSG MEDFIX 2X11","code_information":[{"code":"11605","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":12.5,"setting":"both","billing_class":"facility"}]},{"description":"DSG MEDFIX 4X11","code_information":[{"code":"11606","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":45.55,"discounted_cash":22.77,"setting":"both","billing_class":"facility"}]},{"description":"DSG MEPILEX SACRUM","code_information":[{"code":"11607","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.45,"discounted_cash":14.72,"setting":"both","billing_class":"facility"}]},{"description":"NDL PERC ASPIRATION","code_information":[{"code":"11608","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.15,"discounted_cash":35.08,"setting":"both","billing_class":"facility"}]},{"description":"DSG TEGASORB 6X6","code_information":[{"code":"11609","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":16.13,"setting":"both","billing_class":"facility"}]},{"description":"DSG MEPILEX 9.2X9.2","code_information":[{"code":"11610","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":43.15,"discounted_cash":21.57,"setting":"both","billing_class":"facility"}]},{"description":"COUPLING ROD TO ROD","code_information":[{"code":"11615","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1778.9,"discounted_cash":889.45,"setting":"both","billing_class":"facility"}]},{"description":"CLAMP PIN 5 HOLE","code_information":[{"code":"11616","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1866.5,"discounted_cash":933.25,"setting":"both","billing_class":"facility"}]},{"description":"POST 30 DEG ANGLED","code_information":[{"code":"11617","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":409.85,"discounted_cash":204.93,"setting":"both","billing_class":"facility"}]},{"description":"ROD CONNECTING","code_information":[{"code":"11618","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1297.15,"discounted_cash":648.58,"setting":"both","billing_class":"facility"}]},{"description":"DSG POSTOP APP","code_information":[{"code":"11619","type":"CDM"},{"code":"272","type":"RC"},{"code":"L5450","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.0,"discounted_cash":754.5,"setting":"both","billing_class":"facility"}]},{"description":"SOCK PROSTHETIC","code_information":[{"code":"11620","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":98.95,"discounted_cash":49.48,"setting":"both","billing_class":"facility"}]},{"description":"CAP CATH VALVE RPLC","code_information":[{"code":"11630","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility"}]},{"description":"VALVE LUER ACTIVATED","code_information":[{"code":"11631","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":1.95,"setting":"both","billing_class":"facility"}]},{"description":"STPL RELOAD","code_information":[{"code":"11635","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":260.25,"discounted_cash":130.13,"setting":"both","billing_class":"facility"}]},{"description":"KIT BLOOD WARMING","code_information":[{"code":"11640","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.75,"discounted_cash":24.88,"setting":"both","billing_class":"facility"}]},{"description":"MICROPUNCTURE","code_information":[{"code":"11644","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":119.2,"discounted_cash":59.6,"setting":"both","billing_class":"facility"}]},{"description":"BLADE ARTH STRAIGHT","code_information":[{"code":"11646","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":182.35,"discounted_cash":91.17,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH ENDOSCRUB","code_information":[{"code":"11649","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":175.4,"discounted_cash":87.7,"setting":"both","billing_class":"facility"}]},{"description":"GUIDE MAMMOTOME","code_information":[{"code":"11668","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":15.75,"setting":"both","billing_class":"facility"}]},{"description":"SOLN H20 IRRI 1L BAG","code_information":[{"code":"11671","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.65,"discounted_cash":3.83,"setting":"both","billing_class":"facility"}]},{"description":"BLADE ENDOTRAC","code_information":[{"code":"11672","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.05,"discounted_cash":9.03,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVE FOOT COMPRESS","code_information":[{"code":"11673","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":91.2,"discounted_cash":45.6,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVE CALF COMPRESS","code_information":[{"code":"11674","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.35,"discounted_cash":38.17,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH PINNACLE","code_information":[{"code":"11677","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.4,"discounted_cash":212.7,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH RADIOPAQUE","code_information":[{"code":"11678","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":118.9,"discounted_cash":59.45,"setting":"both","billing_class":"facility"}]},{"description":"GLIDE WIRE","code_information":[{"code":"11679","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":203.45,"discounted_cash":101.72,"setting":"both","billing_class":"facility"}]},{"description":"STRAP CLAVICLE","code_information":[{"code":"11682","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":17.38,"setting":"both","billing_class":"facility"}]},{"description":"TROCAR THORACIC","code_information":[{"code":"11684","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":172.95,"discounted_cash":86.47,"setting":"both","billing_class":"facility"}]},{"description":"KIT INTRODUCER","code_information":[{"code":"11692","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":71.0,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA C02","code_information":[{"code":"11694","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":367.6,"discounted_cash":183.8,"setting":"both","billing_class":"facility"}]},{"description":"CATH FOLEY","code_information":[{"code":"11699","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.55,"discounted_cash":7.28,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP SAME SUBS","code_information":[{"code":"117","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":183.8,"discounted_cash":91.9,"setting":"both","billing_class":"facility"}]},{"description":"CATH SILICONE","code_information":[{"code":"11700","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.8,"discounted_cash":27.9,"setting":"both","billing_class":"facility"}]},{"description":"OST WAFER","code_information":[{"code":"11714","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":2.83,"setting":"both","billing_class":"facility"}]},{"description":"KIT INFLATION DEVICE","code_information":[{"code":"11717","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":199.2,"discounted_cash":99.6,"setting":"both","billing_class":"facility"}]},{"description":"CUP INPUT/OUTPUT","code_information":[{"code":"11723","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.13,"setting":"both","billing_class":"facility"}]},{"description":"ENDO APPLICATOR DUAL","code_information":[{"code":"11726","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":193.3,"discounted_cash":96.65,"setting":"both","billing_class":"facility"}]},{"description":"VISE TORQUE","code_information":[{"code":"11728","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.4,"discounted_cash":12.7,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LIGATOR MULTI","code_information":[{"code":"11740","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":838.3,"discounted_cash":419.15,"setting":"both","billing_class":"facility"}]},{"description":"PROTECTOR ARM ONE ST","code_information":[{"code":"11744","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":74.85,"discounted_cash":37.42,"setting":"both","billing_class":"facility"}]},{"description":"DSG UNNA FLEX BND","code_information":[{"code":"11745","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.4,"discounted_cash":10.7,"setting":"both","billing_class":"facility"}]},{"description":"CANNISTER VAC","code_information":[{"code":"11748","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.85,"discounted_cash":12.93,"setting":"both","billing_class":"facility"}]},{"description":"DSG VAC SM","code_information":[{"code":"11749","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":39.95,"discounted_cash":19.98,"setting":"both","billing_class":"facility"}]},{"description":"KIT DSG VAC SM","code_information":[{"code":"11750","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.65,"discounted_cash":104.83,"setting":"both","billing_class":"facility"}]},{"description":"CAST SPICA THUMB","code_information":[{"code":"11751","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":88.38,"setting":"both","billing_class":"facility"}]},{"description":"BURR EGG","code_information":[{"code":"11753","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":90.8,"discounted_cash":45.4,"setting":"both","billing_class":"facility"}]},{"description":"BLADE SAW","code_information":[{"code":"11755","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.25,"discounted_cash":60.13,"setting":"both","billing_class":"facility"}]},{"description":"CATH ASH SPLIT HEMO","code_information":[{"code":"11758","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.1,"discounted_cash":440.55,"setting":"both","billing_class":"facility"}]},{"description":"CATH NDL TUOHY","code_information":[{"code":"11765","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.85,"discounted_cash":13.93,"setting":"both","billing_class":"facility"}]},{"description":"CEMENT BN MIX BOWL","code_information":[{"code":"11768","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":165.5,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM CHEST DRAIN","code_information":[{"code":"11771","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.8,"discounted_cash":31.4,"setting":"both","billing_class":"facility"}]},{"description":"DSG XEROFORM 4 X 4","code_information":[{"code":"11772","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":2.08,"setting":"both","billing_class":"facility"}]},{"description":"NDL EPIDURAL","code_information":[{"code":"11776","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.6,"discounted_cash":39.3,"setting":"both","billing_class":"facility"}]},{"description":"BOOT WALKING","code_information":[{"code":"11779","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8420","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":196.15,"discounted_cash":98.08,"setting":"both","billing_class":"facility"}]},{"description":"POUCH SPECIMEN RETRV","code_information":[{"code":"11795","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.15,"discounted_cash":120.08,"setting":"both","billing_class":"facility"}]},{"description":"OP BLADDER SCAN","code_information":[{"code":"118","type":"CDM"},{"code":"361","type":"RC"},{"code":"51798","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":287.95,"discounted_cash":143.97,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH ACCESS","code_information":[{"code":"11808","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":122.05,"discounted_cash":61.02,"setting":"both","billing_class":"facility"}]},{"description":"CATH INTRAUTERINE","code_information":[{"code":"11811","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":128.4,"discounted_cash":64.2,"setting":"both","billing_class":"facility"}]},{"description":"WAND TURBO BLADE","code_information":[{"code":"11820","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":547.85,"discounted_cash":273.93,"setting":"both","billing_class":"facility"}]},{"description":"DISSECTOR BLUNT KTTN","code_information":[{"code":"11832","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.75,"discounted_cash":30.88,"setting":"both","billing_class":"facility"}]},{"description":"KIT NEPHROMAX","code_information":[{"code":"11837","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":747.8,"discounted_cash":373.9,"setting":"both","billing_class":"facility"}]},{"description":"SOLN NACL 0.9% 500ML","code_information":[{"code":"11854","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":2.42,"setting":"both","billing_class":"facility"}]},{"description":"TAP BONE","code_information":[{"code":"11859","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":324.65,"discounted_cash":162.32,"setting":"both","billing_class":"facility"}]},{"description":"SOLN NACL .9% 1L","code_information":[{"code":"11863","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.35,"discounted_cash":3.67,"setting":"both","billing_class":"facility"}]},{"description":"LARYNGSCPE FIBR OPTC","code_information":[{"code":"11864","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.8,"discounted_cash":19.4,"setting":"both","billing_class":"facility"}]},{"description":"EAR MINIMUFFS","code_information":[{"code":"11867","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility"}]},{"description":"PROBE TEMPATURE SKIN","code_information":[{"code":"11869","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.35,"discounted_cash":7.67,"setting":"both","billing_class":"facility"}]},{"description":"STPL HEMORROID/PROL","code_information":[{"code":"11880","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1088.75,"discounted_cash":544.38,"setting":"both","billing_class":"facility"}]},{"description":"BRA SURGICAL ZIP XL","code_information":[{"code":"11882","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":149.1,"discounted_cash":74.55,"setting":"both","billing_class":"facility"}]},{"description":"BRA SURGICAL ZIP XXL","code_information":[{"code":"11885","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":157.55,"discounted_cash":78.78,"setting":"both","billing_class":"facility"}]},{"description":"SET EXPLORATION CBD","code_information":[{"code":"11893","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1843.25,"discounted_cash":921.63,"setting":"both","billing_class":"facility"}]},{"description":"SOLN NS 0.9% 500ML","code_information":[{"code":"11895","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.7,"discounted_cash":8.35,"setting":"both","billing_class":"facility"}]},{"description":"SOLN ST WATER 1L","code_information":[{"code":"11897","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":5.78,"setting":"both","billing_class":"facility"}]},{"description":"OP BLADDER IRIG/LAVG","code_information":[{"code":"119","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.79,"discounted_cash":234.4,"setting":"both","billing_class":"facility"}]},{"description":"KNIFE GRAFT","code_information":[{"code":"11900","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":376.8,"discounted_cash":188.4,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE INSULFLATION","code_information":[{"code":"11907","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.5,"discounted_cash":75.75,"setting":"both","billing_class":"facility"}]},{"description":"CLIP ENDO BLEEDER","code_information":[{"code":"11915","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":509.05,"discounted_cash":254.53,"setting":"both","billing_class":"facility"}]},{"description":"CAPSULE BRAVO PH","code_information":[{"code":"11926","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1035.15,"discounted_cash":517.58,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE ANKLE DTRACT","code_information":[{"code":"11927","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":119.6,"discounted_cash":59.8,"setting":"both","billing_class":"facility"}]},{"description":"ENDO MARKER SPOT","code_information":[{"code":"11930","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.35,"discounted_cash":38.17,"setting":"both","billing_class":"facility"}]},{"description":"CATH SUPPORT","code_information":[{"code":"11947","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":952.99,"discounted_cash":476.5,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM CEMENT DELVRY","code_information":[{"code":"11949","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1237.45,"discounted_cash":618.73,"setting":"both","billing_class":"facility"}]},{"description":"BLADE/BURR ARTHROSCO","code_information":[{"code":"11956","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":175.4,"discounted_cash":87.7,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN WOUND","code_information":[{"code":"11960","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.2,"discounted_cash":15.6,"setting":"both","billing_class":"facility"}]},{"description":"KIT REFILL BREAST IM","code_information":[{"code":"11962","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.3,"discounted_cash":20.65,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE HEMOSTASIS","code_information":[{"code":"11966","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":324.1,"discounted_cash":162.05,"setting":"both","billing_class":"facility"}]},{"description":"SET FILTER RETRIEVAL","code_information":[{"code":"11968","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1350.45,"discounted_cash":675.23,"setting":"both","billing_class":"facility"}]},{"description":"BRA SURGICAL ZIP Q","code_information":[{"code":"11969","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":171.15,"discounted_cash":85.58,"setting":"both","billing_class":"facility"}]},{"description":"BLADE SAW STERNUM DI","code_information":[{"code":"11972","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.8,"discounted_cash":51.4,"setting":"both","billing_class":"facility"}]},{"description":"KIT TOTAL ASPIRATION","code_information":[{"code":"11988","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":177.85,"discounted_cash":88.92,"setting":"both","billing_class":"facility"}]},{"description":"M/S 2 OBS ADD HR","code_information":[{"code":"12","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility"}]},{"description":"M/S OP PROCEDURE","code_information":[{"code":"120","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":578.67,"discounted_cash":289.33,"setting":"both","billing_class":"facility"}]},{"description":"KIT ARTLINE","code_information":[{"code":"12001","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.45,"discounted_cash":41.23,"setting":"both","billing_class":"facility"}]},{"description":"STPL PROTACK","code_information":[{"code":"12006","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1658.1,"discounted_cash":829.05,"setting":"both","billing_class":"facility"}]},{"description":"TIP IRRIGTN HI-FLO","code_information":[{"code":"12009","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.35,"discounted_cash":29.68,"setting":"both","billing_class":"facility"}]},{"description":"BURR CUTTING","code_information":[{"code":"12014","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.9,"discounted_cash":168.45,"setting":"both","billing_class":"facility"}]},{"description":"BURR DENTAL","code_information":[{"code":"12015","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.4,"discounted_cash":17.7,"setting":"both","billing_class":"facility"}]},{"description":"NDL PNEUMO","code_information":[{"code":"12021","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":35.75,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE HAND ACCESS","code_information":[{"code":"12026","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1411.95,"discounted_cash":705.98,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM CLOSUR DEVICE","code_information":[{"code":"12038","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":694.45,"discounted_cash":347.23,"setting":"both","billing_class":"facility"}]},{"description":"NDL PARACENTESIS","code_information":[{"code":"12047","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":68.7,"discounted_cash":34.35,"setting":"both","billing_class":"facility"}]},{"description":"NDL BX CO AXIAL","code_information":[{"code":"12061","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1728","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.6,"discounted_cash":33.3,"setting":"both","billing_class":"facility"}]},{"description":"SENSOR EEG MONITOR","code_information":[{"code":"12074","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1728","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.8,"discounted_cash":32.4,"setting":"both","billing_class":"facility"}]},{"description":"DSG PROMOGRAN","code_information":[{"code":"12075","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1728","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":40.15,"discounted_cash":20.07,"setting":"both","billing_class":"facility"}]},{"description":"GEL WOUND 1.5OZ TUBE","code_information":[{"code":"12077","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1728","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":81.05,"discounted_cash":40.52,"setting":"both","billing_class":"facility"}]},{"description":"SET BLOOD COLLECT AW","code_information":[{"code":"12079","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1728","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":1.75,"setting":"both","billing_class":"facility"}]},{"description":"SET PCA PUMP","code_information":[{"code":"12092","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1728","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.95,"discounted_cash":16.48,"setting":"both","billing_class":"facility"}]},{"description":"NDL TEMNO","code_information":[{"code":"12097","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1728","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":152.25,"discounted_cash":76.13,"setting":"both","billing_class":"facility"}]},{"description":"BALLS JURGAN","code_information":[{"code":"12099","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1728","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.9,"discounted_cash":10.95,"setting":"both","billing_class":"facility"}]},{"description":"KIT HYPO/HYPER WRAP","code_information":[{"code":"12100","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1728","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":419.35,"discounted_cash":209.68,"setting":"both","billing_class":"facility"}]},{"description":"NDL ARTERIAL","code_information":[{"code":"12104","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1728","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.4,"discounted_cash":7.7,"setting":"both","billing_class":"facility"}]},{"description":"SET PRESSURE MONITOR","code_information":[{"code":"12108","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1728","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1286.6,"discounted_cash":643.3,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLLN OCCLUSION","code_information":[{"code":"12119","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":462.88,"discounted_cash":231.44,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE EXPANDER","code_information":[{"code":"12133","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":385.4,"discounted_cash":192.7,"setting":"both","billing_class":"facility"}]},{"description":"KIT RF ELECTRD SNGL","code_information":[{"code":"12138","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":4052.05,"discounted_cash":2026.03,"setting":"both","billing_class":"facility"}]},{"description":"WAND COBLATION ENT","code_information":[{"code":"12146","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":715.2,"discounted_cash":357.6,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM SUCTION DRAIN","code_information":[{"code":"12148","type":"CDM"},{"code":"270","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.2,"discounted_cash":26.1,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA TUNNEL TIB","code_information":[{"code":"12151","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.6,"discounted_cash":36.3,"setting":"both","billing_class":"facility"}]},{"description":"PATCH OTOLOGIC LAM","code_information":[{"code":"12156","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":403.35,"discounted_cash":201.68,"setting":"both","billing_class":"facility"}]},{"description":"NDL TRANS ORAL","code_information":[{"code":"12157","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":218.9,"discounted_cash":109.45,"setting":"both","billing_class":"facility"}]},{"description":"PILLOW ARM","code_information":[{"code":"12159","type":"CDM"},{"code":"270","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.15,"discounted_cash":32.08,"setting":"both","billing_class":"facility"}]},{"description":"DRILL BIT QC","code_information":[{"code":"12160","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":228.75,"discounted_cash":114.38,"setting":"both","billing_class":"facility"}]},{"description":"RETRACTOR SKW","code_information":[{"code":"12161","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":813.75,"discounted_cash":406.88,"setting":"both","billing_class":"facility"}]},{"description":"KIT ACESSORY UR IMP","code_information":[{"code":"12162","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1718.7,"discounted_cash":859.35,"setting":"both","billing_class":"facility"}]},{"description":"KIT CATH ANTIRETRO","code_information":[{"code":"12163","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1066.4,"discounted_cash":533.2,"setting":"both","billing_class":"facility"}]},{"description":"NDL ROTATOR CUFF MIN","code_information":[{"code":"12165","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":191.5,"setting":"both","billing_class":"facility"}]},{"description":"STIMULATOR ENT PROBE","code_information":[{"code":"12166","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":331.8,"discounted_cash":165.9,"setting":"both","billing_class":"facility"}]},{"description":"OST POUCH URO","code_information":[{"code":"12175","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.7,"discounted_cash":10.85,"setting":"both","billing_class":"facility"}]},{"description":"KIT NDL GUIDE US","code_information":[{"code":"12177","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.4,"discounted_cash":37.7,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH GUIDING","code_information":[{"code":"12178","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":265.8,"discounted_cash":132.9,"setting":"both","billing_class":"facility"}]},{"description":"KIT NDL ACCESS","code_information":[{"code":"12179","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.75,"discounted_cash":370.38,"setting":"both","billing_class":"facility"}]},{"description":"NDL THIN WALL W/O BP","code_information":[{"code":"12182","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":4.83,"setting":"both","billing_class":"facility"}]},{"description":"PATCH SYNTEK NT","code_information":[{"code":"12184","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":403.35,"discounted_cash":201.68,"setting":"both","billing_class":"facility"}]},{"description":"DSG VAC MED","code_information":[{"code":"12186","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":169.45,"discounted_cash":84.72,"setting":"both","billing_class":"facility"}]},{"description":"DSG VAC LG","code_information":[{"code":"12187","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":180.1,"discounted_cash":90.05,"setting":"both","billing_class":"facility"}]},{"description":"CATH PLEURAL","code_information":[{"code":"12189","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1395.3,"discounted_cash":697.65,"setting":"both","billing_class":"facility"}]},{"description":"MARKER PASSIVE REFLC","code_information":[{"code":"12209","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":309.25,"discounted_cash":154.63,"setting":"both","billing_class":"facility"}]},{"description":"WAND COBLATION SPINE","code_information":[{"code":"12210","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5051.05,"discounted_cash":2525.53,"setting":"both","billing_class":"facility"}]},{"description":"SET NDL IO","code_information":[{"code":"12215","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":333.25,"discounted_cash":166.63,"setting":"both","billing_class":"facility"}]},{"description":"DRILL BIT FLUTE","code_information":[{"code":"12222","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":542.2,"discounted_cash":271.1,"setting":"both","billing_class":"facility"}]},{"description":"INTRODUCER LEAD NSTM","code_information":[{"code":"12224","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":412.5,"setting":"both","billing_class":"facility"}]},{"description":"TUBE TRACH NEO/PEDI","code_information":[{"code":"12231","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":48.25,"setting":"both","billing_class":"facility"}]},{"description":"FLOSEAL MATRIX 10ML","code_information":[{"code":"12232","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":736.75,"discounted_cash":368.38,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM FECAL MGMT","code_information":[{"code":"12234","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":231.5,"setting":"both","billing_class":"facility"}]},{"description":"CABLE TRIAL NEUROSTM","code_information":[{"code":"12236","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":617.35,"discounted_cash":308.68,"setting":"both","billing_class":"facility"}]},{"description":"WAND ABLATION DISP","code_information":[{"code":"12239","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2563.35,"discounted_cash":1281.67,"setting":"both","billing_class":"facility"}]},{"description":"FLOSEAL MATRIX 5ML","code_information":[{"code":"12246","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.5,"discounted_cash":290.25,"setting":"both","billing_class":"facility"}]},{"description":"SET INTRODUCER","code_information":[{"code":"12259","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":186.95,"discounted_cash":93.47,"setting":"both","billing_class":"facility"}]},{"description":"SET INTRODUCER PTFE","code_information":[{"code":"12267","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":284.5,"discounted_cash":142.25,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM NURSING SUPP","code_information":[{"code":"12268","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.45,"discounted_cash":14.72,"setting":"both","billing_class":"facility"}]},{"description":"PACK LAP PELVIC","code_information":[{"code":"12281","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":315.65,"discounted_cash":157.82,"setting":"both","billing_class":"facility"}]},{"description":"KIT GASTROSTOMY >3.0","code_information":[{"code":"12283","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.75,"discounted_cash":151.88,"setting":"both","billing_class":"facility"}]},{"description":"TRAY CVA W/DSG","code_information":[{"code":"12285","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.4,"discounted_cash":18.7,"setting":"both","billing_class":"facility"}]},{"description":"SET CATH SUPRAPUBIC","code_information":[{"code":"12291","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2209.85,"discounted_cash":1104.92,"setting":"both","billing_class":"facility"}]},{"description":"CATH THORACIC ANGLED","code_information":[{"code":"12293","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.7,"discounted_cash":17.85,"setting":"both","billing_class":"facility"}]},{"description":"BINDER ABDOMINAL XL","code_information":[{"code":"12295","type":"CDM"},{"code":"270","type":"RC"},{"code":"C2618","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.15,"discounted_cash":31.57,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE G/BUTTON RPLC","code_information":[{"code":"12303","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":333.25,"discounted_cash":166.63,"setting":"both","billing_class":"facility"}]},{"description":"INSTRUMENT SUCT DISP","code_information":[{"code":"12308","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.6,"discounted_cash":7.3,"setting":"both","billing_class":"facility"}]},{"description":"TUBE TRACH CUFF/UNCF","code_information":[{"code":"12311","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":128.35,"discounted_cash":64.17,"setting":"both","billing_class":"facility"}]},{"description":"KIT PEDI IO INFUSION","code_information":[{"code":"12323","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.7,"discounted_cash":147.85,"setting":"both","billing_class":"facility"}]},{"description":"KIT OST URO W/ADAPT","code_information":[{"code":"12326","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":13.63,"setting":"both","billing_class":"facility"}]},{"description":"PROTECTOR EYE","code_information":[{"code":"12327","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":2.0,"setting":"both","billing_class":"facility"}]},{"description":"IRRIGATOR HYDRO SURG","code_information":[{"code":"12328","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.8,"discounted_cash":15.4,"setting":"both","billing_class":"facility"}]},{"description":"VALVE SUCTION","code_information":[{"code":"12329","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":269.45,"discounted_cash":134.72,"setting":"both","billing_class":"facility"}]},{"description":"CATH FOLEY 2-WAY 3CC","code_information":[{"code":"12330","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":15.75,"setting":"both","billing_class":"facility"}]},{"description":"NDL SUTURE PASSER","code_information":[{"code":"12337","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":524.75,"discounted_cash":262.38,"setting":"both","billing_class":"facility"}]},{"description":"SET IV FILTER ADD ON","code_information":[{"code":"12338","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":3.5,"setting":"both","billing_class":"facility"}]},{"description":"TROCAR 11MM","code_information":[{"code":"12342","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":203.5,"discounted_cash":101.75,"setting":"both","billing_class":"facility"}]},{"description":"KIT CEMENT INJECTOR","code_information":[{"code":"12345","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":731.65,"discounted_cash":365.82,"setting":"both","billing_class":"facility"}]},{"description":"RETRACTOR CHEEK","code_information":[{"code":"12350","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.9,"discounted_cash":36.45,"setting":"both","billing_class":"facility"}]},{"description":"DRILL TWIST W/STOP","code_information":[{"code":"12355","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":389.3,"discounted_cash":194.65,"setting":"both","billing_class":"facility"}]},{"description":"MATTRESS WAFFLE W/P","code_information":[{"code":"12356","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":184.15,"discounted_cash":92.08,"setting":"both","billing_class":"facility"}]},{"description":"SOLN NS IRRI 1L BAG","code_information":[{"code":"12358","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":15.15,"setting":"both","billing_class":"facility"}]},{"description":"DSG ACTICOAT FLEX 3","code_information":[{"code":"12360","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":21.02,"setting":"both","billing_class":"facility"}]},{"description":"OASIS TRILAYER SQ CM","code_information":[{"code":"12363","type":"CDM"},{"code":"636","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":51.35,"discounted_cash":25.68,"setting":"both","modifier_code":["Q4","32"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier Q4: Service for ordering/referring physician qualifies as a service exemption | Modifier 32: Mandated Services"}]},{"description":"PROBE CRYO","code_information":[{"code":"12364","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1389.0,"discounted_cash":694.5,"setting":"both","modifier_code":["Q4","32"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier Q4: Service for ordering/referring physician qualifies as a service exemption | Modifier 32: Mandated Services"}]},{"description":"SYSTEM STONE CATCHER","code_information":[{"code":"12366","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":259.35,"discounted_cash":129.68,"setting":"both","modifier_code":["Q4","32"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier Q4: Service for ordering/referring physician qualifies as a service exemption | Modifier 32: Mandated Services"}]},{"description":"TIP PHACO","code_information":[{"code":"12367","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.6,"discounted_cash":86.8,"setting":"both","modifier_code":["Q4","32"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier Q4: Service for ordering/referring physician qualifies as a service exemption | Modifier 32: Mandated Services"}]},{"description":"WRENCH HEX","code_information":[{"code":"12368","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":177.85,"discounted_cash":88.92,"setting":"both","modifier_code":["Q4","32"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier Q4: Service for ordering/referring physician qualifies as a service exemption | Modifier 32: Mandated Services"}]},{"description":"CANNULA CEMENT","code_information":[{"code":"12370","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.05,"discounted_cash":101.03,"setting":"both","modifier_code":["Q4","32"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier Q4: Service for ordering/referring physician qualifies as a service exemption | Modifier 32: Mandated Services"}]},{"description":"CANNISTER DRAIN","code_information":[{"code":"12371","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":19.63,"setting":"both","modifier_code":["Q4","32"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier Q4: Service for ordering/referring physician qualifies as a service exemption | Modifier 32: Mandated Services"}]},{"description":"TRACKER PATIENT ENT","code_information":[{"code":"12374","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":445.7,"discounted_cash":222.85,"setting":"both","modifier_code":["Q4","32"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier Q4: Service for ordering/referring physician qualifies as a service exemption | Modifier 32: Mandated Services"}]},{"description":"TRACKER INSTRMNT ENT","code_information":[{"code":"12376","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":445.7,"discounted_cash":222.85,"setting":"both","modifier_code":["Q4","32"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier Q4: Service for ordering/referring physician qualifies as a service exemption | Modifier 32: Mandated Services"}]},{"description":"NEUROSTIMULATOR EXTE","code_information":[{"code":"12377","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1462.9,"discounted_cash":731.45,"setting":"both","billing_class":"facility"}]},{"description":"ALLODERM 6X16 96 SQ","code_information":[{"code":"12378","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4116","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":105.86,"discounted_cash":52.93,"setting":"both","billing_class":"facility"}]},{"description":"CABLE INTERSTIM TEST","code_information":[{"code":"12379","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4116","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":243.6,"discounted_cash":121.8,"setting":"both","billing_class":"facility"}]},{"description":"POWDER WOUND 100MG","code_information":[{"code":"12382","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4118","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":855.2,"discounted_cash":427.6,"setting":"both","billing_class":"facility"}]},{"description":"CATH TA NONLAS GRP A","code_information":[{"code":"12383","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":190.56,"discounted_cash":95.28,"setting":"both","billing_class":"facility"}]},{"description":"CATH TA NONLAS GRP D","code_information":[{"code":"12386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":645.13,"discounted_cash":322.56,"setting":"both","billing_class":"facility"}]},{"description":"CATH TA NONLAS GRP E","code_information":[{"code":"12387","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":879.68,"discounted_cash":439.84,"setting":"both","billing_class":"facility"}]},{"description":"CATH TA NONLAS GRP F","code_information":[{"code":"12388","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1172.96,"discounted_cash":586.48,"setting":"both","billing_class":"facility"}]},{"description":"CATH TA NONLAS GRP J","code_information":[{"code":"12392","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2052.69,"discounted_cash":1026.35,"setting":"both","billing_class":"facility"}]},{"description":"CATH TLA ROTATIONAL","code_information":[{"code":"12402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1724","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":7466.63,"discounted_cash":3733.32,"setting":"both","billing_class":"facility"}]},{"description":"TISSUE EXPANDER G34","code_information":[{"code":"12403","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1724","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.05,"discounted_cash":701.52,"setting":"both","billing_class":"facility"}]},{"description":"EXPANDER TISSUE G35","code_information":[{"code":"12404","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1724","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1473.2,"discounted_cash":736.6,"setting":"both","billing_class":"facility"}]},{"description":"EXPANDER TISSUE G40","code_information":[{"code":"12409","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1724","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3156.95,"discounted_cash":1578.47,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G04","code_information":[{"code":"12413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.16,"discounted_cash":17.58,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G05","code_information":[{"code":"12414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":44.31,"discounted_cash":22.16,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G06","code_information":[{"code":"12415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.12,"discounted_cash":24.56,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G07","code_information":[{"code":"12416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.09,"discounted_cash":29.55,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G08","code_information":[{"code":"12417","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.73,"discounted_cash":32.87,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G09","code_information":[{"code":"12418","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.83,"discounted_cash":36.91,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G10","code_information":[{"code":"12419","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.14,"discounted_cash":41.07,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G11","code_information":[{"code":"12420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.86,"discounted_cash":41.93,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G12","code_information":[{"code":"12421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":91.59,"discounted_cash":45.8,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G13","code_information":[{"code":"12422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":98.86,"discounted_cash":49.43,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G14","code_information":[{"code":"12423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.59,"discounted_cash":53.3,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G15","code_information":[{"code":"12424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":114.32,"discounted_cash":57.16,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G16","code_information":[{"code":"12425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G17","code_information":[{"code":"12426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":129.63,"discounted_cash":64.81,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G18","code_information":[{"code":"12427","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":137.05,"discounted_cash":68.53,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G19","code_information":[{"code":"12428","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":144.58,"discounted_cash":72.29,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G20","code_information":[{"code":"12429","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":152.47,"discounted_cash":76.23,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G21","code_information":[{"code":"12430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":190.56,"discounted_cash":95.28,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G22","code_information":[{"code":"12431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":211.25,"discounted_cash":105.63,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G23","code_information":[{"code":"12432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":246.15,"discounted_cash":123.08,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G24","code_information":[{"code":"12433","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":281.63,"discounted_cash":140.81,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G25","code_information":[{"code":"12434","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":316.74,"discounted_cash":158.37,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G26","code_information":[{"code":"12435","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.06,"discounted_cash":176.03,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G27","code_information":[{"code":"12436","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.84,"discounted_cash":241.92,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G28","code_information":[{"code":"12437","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":747.28,"discounted_cash":373.64,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G29","code_information":[{"code":"12438","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":806.79,"discounted_cash":403.39,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G30","code_information":[{"code":"12439","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":879.68,"discounted_cash":439.84,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G31","code_information":[{"code":"12440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1026.35,"discounted_cash":513.17,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G32","code_information":[{"code":"12441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1172.96,"discounted_cash":586.48,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G33","code_information":[{"code":"12442","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1319.63,"discounted_cash":659.82,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G34","code_information":[{"code":"12443","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1466.19,"discounted_cash":733.1,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G35","code_information":[{"code":"12444","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.49,"discounted_cash":769.75,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G36","code_information":[{"code":"12445","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1796.04,"discounted_cash":898.02,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE G37","code_information":[{"code":"12446","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2052.69,"discounted_cash":1026.35,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G01","code_information":[{"code":"12447","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G02","code_information":[{"code":"12448","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.9,"discounted_cash":8.45,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G03","code_information":[{"code":"12449","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.3,"discounted_cash":12.65,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G04","code_information":[{"code":"12450","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.65,"discounted_cash":16.82,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G05","code_information":[{"code":"12451","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.15,"discounted_cash":21.07,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G06","code_information":[{"code":"12452","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":23.5,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G07","code_information":[{"code":"12453","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":27.5,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G08","code_information":[{"code":"12454","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.8,"discounted_cash":31.4,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G09","code_information":[{"code":"12455","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.8,"discounted_cash":35.4,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G10","code_information":[{"code":"12456","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.6,"discounted_cash":39.3,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G11","code_information":[{"code":"12457","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":40.13,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G12","code_information":[{"code":"12458","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.65,"discounted_cash":43.83,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G13","code_information":[{"code":"12459","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.6,"discounted_cash":47.3,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G14","code_information":[{"code":"12460","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G15","code_information":[{"code":"12461","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.4,"discounted_cash":54.7,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G16","code_information":[{"code":"12462","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.65,"discounted_cash":58.33,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G17","code_information":[{"code":"12463","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G18","code_information":[{"code":"12464","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":131.1,"discounted_cash":65.55,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G19","code_information":[{"code":"12465","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.55,"discounted_cash":69.28,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G20","code_information":[{"code":"12466","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":145.9,"discounted_cash":72.95,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G21","code_information":[{"code":"12467","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":182.35,"discounted_cash":91.17,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G22","code_information":[{"code":"12468","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.05,"discounted_cash":101.03,"setting":"both","billing_class":"facility"}]},{"description":"BANDAGE/DSG G23","code_information":[{"code":"12469","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.65,"discounted_cash":117.83,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G01","code_information":[{"code":"12470","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility"}]},{"description":"CONNECTOR PERFECTPAS","code_information":[{"code":"12471","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.25,"discounted_cash":315.13,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G03","code_information":[{"code":"12472","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.3,"discounted_cash":12.65,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G04","code_information":[{"code":"12473","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.7,"discounted_cash":16.85,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G05","code_information":[{"code":"12474","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":21.02,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G06","code_information":[{"code":"12475","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":22.38,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G07","code_information":[{"code":"12476","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.4,"discounted_cash":26.2,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G08","code_information":[{"code":"12477","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.8,"discounted_cash":29.9,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G09","code_information":[{"code":"12478","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":67.45,"discounted_cash":33.73,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G10","code_information":[{"code":"12479","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.35,"discounted_cash":38.17,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G11","code_information":[{"code":"12480","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.45,"discounted_cash":38.23,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G12","code_information":[{"code":"12481","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.65,"discounted_cash":43.83,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G13","code_information":[{"code":"12482","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.6,"discounted_cash":47.3,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G14","code_information":[{"code":"12483","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G15","code_information":[{"code":"12484","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.4,"discounted_cash":54.7,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G16","code_information":[{"code":"12485","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.75,"discounted_cash":58.38,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G17","code_information":[{"code":"12486","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.05,"discounted_cash":62.02,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G18","code_information":[{"code":"12487","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":131.15,"discounted_cash":65.58,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BIT G19","code_information":[{"code":"12488","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.55,"discounted_cash":69.28,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G20","code_information":[{"code":"12489","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.4,"discounted_cash":101.2,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G21","code_information":[{"code":"12490","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":185.6,"discounted_cash":92.8,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G22","code_information":[{"code":"12491","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.25,"discounted_cash":101.13,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G23","code_information":[{"code":"12492","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.45,"discounted_cash":117.72,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G24","code_information":[{"code":"12493","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":269.35,"discounted_cash":134.68,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G25","code_information":[{"code":"12494","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":307.85,"discounted_cash":153.93,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BIT G26","code_information":[{"code":"12495","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.8,"discounted_cash":168.4,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BIT G27","code_information":[{"code":"12496","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":231.5,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BIT G28","code_information":[{"code":"12497","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":321.5,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G29","code_information":[{"code":"12498","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":768.65,"discounted_cash":384.32,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G30","code_information":[{"code":"12499","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.75,"discounted_cash":420.38,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G31","code_information":[{"code":"12500","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":992.75,"discounted_cash":496.38,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G32","code_information":[{"code":"12501","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1148.2,"discounted_cash":574.1,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G33","code_information":[{"code":"12502","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1262.9,"discounted_cash":631.45,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G34","code_information":[{"code":"12503","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1446.3,"discounted_cash":723.15,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G35","code_information":[{"code":"12504","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1514.95,"discounted_cash":757.48,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G36","code_information":[{"code":"12505","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1688.7,"discounted_cash":844.35,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G37","code_information":[{"code":"12506","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1964.5,"discounted_cash":982.25,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G38","code_information":[{"code":"12507","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2168.65,"discounted_cash":1084.33,"setting":"both","billing_class":"facility"}]},{"description":"BURR/BLADE/BITS G39","code_information":[{"code":"12508","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2455.4,"discounted_cash":1227.7,"setting":"both","billing_class":"facility"}]},{"description":"ADAPTER G08","code_information":[{"code":"12511","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.8,"discounted_cash":31.4,"setting":"both","billing_class":"facility"}]},{"description":"ADAPTER G19","code_information":[{"code":"12513","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.55,"discounted_cash":69.28,"setting":"both","billing_class":"facility"}]},{"description":"ADAPTER G28","code_information":[{"code":"12515","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":715.45,"discounted_cash":357.73,"setting":"both","billing_class":"facility"}]},{"description":"SPONGE SURGIFOAM 8CM","code_information":[{"code":"12517","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility"}]},{"description":"SPONGE SURGIFOAM 6X2","code_information":[{"code":"12518","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":6.75,"setting":"both","billing_class":"facility"}]},{"description":"SYSTM PAIN MGT 400 D","code_information":[{"code":"12519","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":787.1,"discounted_cash":393.55,"setting":"both","billing_class":"facility"}]},{"description":"PRIMATRIX 6X6 36 SQ","code_information":[{"code":"12520","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":148.08,"discounted_cash":74.04,"setting":"both","billing_class":"facility"}]},{"description":"TRAYS STERILE DISP G","code_information":[{"code":"12521","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.8,"discounted_cash":10.9,"setting":"both","billing_class":"facility"}]},{"description":"TRAYS STERILE G12 22","code_information":[{"code":"12522","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.45,"discounted_cash":38.73,"setting":"both","billing_class":"facility"}]},{"description":"TRAYS STR DISP G13","code_information":[{"code":"12523","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.6,"discounted_cash":47.3,"setting":"both","billing_class":"facility"}]},{"description":"TRAYS STERILE DISP G","code_information":[{"code":"12524","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":112.7,"discounted_cash":56.35,"setting":"both","billing_class":"facility"}]},{"description":"TRAYS STERILE DISP G","code_information":[{"code":"12525","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":119.95,"discounted_cash":59.98,"setting":"both","billing_class":"facility"}]},{"description":"TRAYS STR DISP G21","code_information":[{"code":"12526","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":182.05,"discounted_cash":91.03,"setting":"both","billing_class":"facility"}]},{"description":"TRAYS STR DISP G24","code_information":[{"code":"12527","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":269.45,"discounted_cash":134.72,"setting":"both","billing_class":"facility"}]},{"description":"TRAYS STR DISP G27","code_information":[{"code":"12528","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":231.5,"setting":"both","billing_class":"facility"}]},{"description":"TRAY STERLE DISP G28","code_information":[{"code":"12529","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":617.15,"discounted_cash":308.57,"setting":"both","billing_class":"facility"}]},{"description":"TRAY STERLE DISP G29","code_information":[{"code":"12530","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":771.85,"discounted_cash":385.93,"setting":"both","billing_class":"facility"}]},{"description":"TYS STERILE DISP G30","code_information":[{"code":"12531","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":801.7,"discounted_cash":400.85,"setting":"both","billing_class":"facility"}]},{"description":"TRAY STERLE DISP G31","code_information":[{"code":"12532","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":935.4,"discounted_cash":467.7,"setting":"both","billing_class":"facility"}]},{"description":"TRAY STERLE DISP G32","code_information":[{"code":"12533","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1069.0,"discounted_cash":534.5,"setting":"both","billing_class":"facility"}]},{"description":"TRAY STERLE DISP G33","code_information":[{"code":"12534","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1202.4,"discounted_cash":601.2,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA G02","code_information":[{"code":"12536","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.85,"discounted_cash":8.43,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA G03","code_information":[{"code":"12537","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.3,"discounted_cash":12.65,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA G06","code_information":[{"code":"12538","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":23.5,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA G08","code_information":[{"code":"12539","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.8,"discounted_cash":31.4,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA G11","code_information":[{"code":"12540","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":40.13,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA G13","code_information":[{"code":"12541","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":49.5,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA G16","code_information":[{"code":"12543","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":135.6,"discounted_cash":67.8,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA G17","code_information":[{"code":"12544","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.15,"discounted_cash":62.08,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA  G18","code_information":[{"code":"12545","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":131.15,"discounted_cash":65.58,"setting":"both","billing_class":"facility"}]},{"description":"VENOM CANNULA 18GA","code_information":[{"code":"12546","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":182.35,"discounted_cash":91.17,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA G23","code_information":[{"code":"12547","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.65,"discounted_cash":117.83,"setting":"both","billing_class":"facility"}]},{"description":"CATH IV G04","code_information":[{"code":"12551","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.65,"discounted_cash":16.82,"setting":"both","billing_class":"facility"}]},{"description":"CATH HEMO/PR LTM G23","code_information":[{"code":"12552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":258.59,"discounted_cash":129.29,"setting":"both","billing_class":"facility"}]},{"description":"CATH HEMO/PR LTM G29","code_information":[{"code":"12553","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.92,"discounted_cash":423.46,"setting":"both","billing_class":"facility"}]},{"description":"CATH HEMO/PR LTM G30","code_information":[{"code":"12554","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":923.68,"discounted_cash":461.84,"setting":"both","billing_class":"facility"}]},{"description":"CATH HEMO/PR LTM G31","code_information":[{"code":"12555","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1026.35,"discounted_cash":513.17,"setting":"both","billing_class":"facility"}]},{"description":"CATH HEMO/PR LTM G32","code_information":[{"code":"12556","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1172.96,"discounted_cash":586.48,"setting":"both","billing_class":"facility"}]},{"description":"CAT HEMO/PER LTM G34","code_information":[{"code":"12557","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1540.02,"discounted_cash":770.01,"setting":"both","billing_class":"facility"}]},{"description":"CAT HEM/PERI LTM G35","code_information":[{"code":"12558","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.49,"discounted_cash":769.75,"setting":"both","billing_class":"facility"}]},{"description":"CAT HEM/PERI LTM G40","code_information":[{"code":"12559","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3298.91,"discounted_cash":1649.45,"setting":"both","billing_class":"facility"}]},{"description":"CAT HEM/PERI LTM G42","code_information":[{"code":"12560","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5498.27,"discounted_cash":2749.14,"setting":"both","billing_class":"facility"}]},{"description":"RELIEVA SPINPLS 6X16","code_information":[{"code":"12561","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3909.24,"discounted_cash":1954.62,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE ACCLARENT INF","code_information":[{"code":"12562","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":228.35,"discounted_cash":114.17,"setting":"both","billing_class":"facility"}]},{"description":"CATH IV US G40","code_information":[{"code":"12563","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1753","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3299.01,"discounted_cash":1649.51,"setting":"both","billing_class":"facility"}]},{"description":"CATH DRAINAGE G06","code_information":[{"code":"12565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.12,"discounted_cash":24.56,"setting":"both","billing_class":"facility"}]},{"description":"CATH DRAINAGE G07","code_information":[{"code":"12566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.48,"discounted_cash":28.74,"setting":"both","billing_class":"facility"}]},{"description":"CATH DRAINAGE G23","code_information":[{"code":"12572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":246.15,"discounted_cash":123.08,"setting":"both","billing_class":"facility"}]},{"description":"PROBE ULTASOUND 8G","code_information":[{"code":"12573","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.15,"discounted_cash":360.57,"setting":"both","billing_class":"facility"}]},{"description":"MARKER BRST HYDROMRK","code_information":[{"code":"12574","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":315.96,"discounted_cash":157.98,"setting":"both","billing_class":"facility"}]},{"description":"MAMMOMARKER VAR SIZE","code_information":[{"code":"12575","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":276.14,"discounted_cash":138.07,"setting":"both","billing_class":"facility"}]},{"description":"CATH DRAINAGE G27","code_information":[{"code":"12576","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.84,"discounted_cash":241.92,"setting":"both","billing_class":"facility"}]},{"description":"CATH DRAINAGE G28","code_information":[{"code":"12577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":645.13,"discounted_cash":322.56,"setting":"both","billing_class":"facility"}]},{"description":"PROBE MAMMOTOME","code_information":[{"code":"12578","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":769.35,"discounted_cash":384.68,"setting":"both","billing_class":"facility"}]},{"description":"PROBE GUIDE 8G","code_information":[{"code":"12579","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.35,"discounted_cash":13.18,"setting":"both","billing_class":"facility"}]},{"description":"CATH ANGIOGRAPHY G06","code_information":[{"code":"12580","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":23.5,"setting":"both","billing_class":"facility"}]},{"description":"CATH ANGIOGRAPHY G08","code_information":[{"code":"12581","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.8,"discounted_cash":31.4,"setting":"both","billing_class":"facility"}]},{"description":"CATH ANGIOGRAPHY G09","code_information":[{"code":"12582","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.8,"discounted_cash":35.4,"setting":"both","billing_class":"facility"}]},{"description":"CATH ANGIOGRAPHY G21","code_information":[{"code":"12583","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":182.35,"discounted_cash":91.17,"setting":"both","billing_class":"facility"}]},{"description":"CATH ANGIOGRAPHY G26","code_information":[{"code":"12585","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.9,"discounted_cash":168.45,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING G05","code_information":[{"code":"12586","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":44.31,"discounted_cash":22.16,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING G14","code_information":[{"code":"12587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.59,"discounted_cash":53.3,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING G24","code_information":[{"code":"12588","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":281.58,"discounted_cash":140.79,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING G29","code_information":[{"code":"12589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":806.37,"discounted_cash":403.19,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING G30","code_information":[{"code":"12590","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":879.68,"discounted_cash":439.84,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING G31","code_information":[{"code":"12591","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1026.35,"discounted_cash":513.17,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING G34","code_information":[{"code":"12592","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1466.19,"discounted_cash":733.1,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING G35","code_information":[{"code":"12593","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.49,"discounted_cash":769.75,"setting":"both","billing_class":"facility"}]},{"description":"SHEATHS/COVERS G34","code_information":[{"code":"12594","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1333.89,"discounted_cash":666.95,"setting":"both","billing_class":"facility"}]},{"description":"CLIPS/CLIP APPLR G14","code_information":[{"code":"12596","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility"}]},{"description":"CLIPS G21","code_information":[{"code":"12597","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.65,"discounted_cash":86.83,"setting":"both","billing_class":"facility"}]},{"description":"CLIPS G28","code_information":[{"code":"12598","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":730.5,"discounted_cash":365.25,"setting":"both","billing_class":"facility"}]},{"description":"CLIPS G29","code_information":[{"code":"12599","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.6,"discounted_cash":399.8,"setting":"both","billing_class":"facility"}]},{"description":"GRAFT AFFINITY 1.5CM","code_information":[{"code":"12600","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4159","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":533.3,"discounted_cash":266.65,"setting":"both","billing_class":"facility"}]},{"description":"GRAFT AFFINITY 2.5CM","code_information":[{"code":"12601","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4159","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":430.3,"discounted_cash":215.15,"setting":"both","billing_class":"facility"}]},{"description":"NUSHIELD ALLOGR. 1.6","code_information":[{"code":"12602","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4160","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":776.44,"discounted_cash":388.22,"setting":"both","billing_class":"facility"}]},{"description":"NUSHIELD ALLOGR. 2X3","code_information":[{"code":"12603","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4160","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.04,"discounted_cash":177.02,"setting":"both","billing_class":"facility"}]},{"description":"NUSHIELD ALLOGR. 2X4","code_information":[{"code":"12604","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4160","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":325.49,"discounted_cash":162.75,"setting":"both","billing_class":"facility"}]},{"description":"NUSHIELD ALLOGR. 3X4","code_information":[{"code":"12605","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4160","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":319.29,"discounted_cash":159.65,"setting":"both","billing_class":"facility"}]},{"description":"ENDOSCOPIC RETRIEVAL","code_information":[{"code":"12606","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4160","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":715.45,"discounted_cash":357.73,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM FASCIA CLOSUR","code_information":[{"code":"12607","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4160","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":276.35,"discounted_cash":138.18,"setting":"both","billing_class":"facility"}]},{"description":"TUBE FEEDING MIC LP","code_information":[{"code":"12608","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4160","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.15,"discounted_cash":130.57,"setting":"both","billing_class":"facility"}]},{"description":"TUBE FEED JEJUNAL 16","code_information":[{"code":"12609","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4160","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":747.2,"discounted_cash":373.6,"setting":"both","billing_class":"facility"}]},{"description":"DRSSNG SINUFOAM RHIN","code_information":[{"code":"12610","type":"CDM"},{"code":"623","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":432.05,"discounted_cash":216.03,"setting":"both","billing_class":"facility"}]},{"description":"WAND TURBINATOR 2.9M","code_information":[{"code":"12611","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":647.2,"discounted_cash":323.6,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G11","code_information":[{"code":"12612","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":40.13,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G12","code_information":[{"code":"12613","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.65,"discounted_cash":43.83,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G13","code_information":[{"code":"12614","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.65,"discounted_cash":47.33,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G14","code_information":[{"code":"12615","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G15","code_information":[{"code":"12616","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.4,"discounted_cash":54.7,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G16","code_information":[{"code":"12617","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.75,"discounted_cash":58.38,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G17","code_information":[{"code":"12618","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.05,"discounted_cash":62.02,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G18","code_information":[{"code":"12619","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":133.85,"discounted_cash":66.92,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G19","code_information":[{"code":"12620","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.55,"discounted_cash":69.28,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G20","code_information":[{"code":"12621","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":145.9,"discounted_cash":72.95,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G21","code_information":[{"code":"12622","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":182.35,"discounted_cash":91.17,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G22","code_information":[{"code":"12623","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.05,"discounted_cash":101.03,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G23","code_information":[{"code":"12624","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.65,"discounted_cash":117.83,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G24","code_information":[{"code":"12625","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":269.15,"discounted_cash":134.57,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G25","code_information":[{"code":"12626","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.1,"discounted_cash":151.55,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G26","code_information":[{"code":"12627","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.8,"discounted_cash":168.4,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G27","code_information":[{"code":"12628","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":231.5,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G28","code_information":[{"code":"12629","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":617.35,"discounted_cash":308.68,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G29","code_information":[{"code":"12630","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":771.65,"discounted_cash":385.82,"setting":"both","billing_class":"facility"}]},{"description":"TROCARS G30","code_information":[{"code":"12631","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6215","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":842.15,"discounted_cash":421.07,"setting":"both","billing_class":"facility"}]},{"description":"DSG OASIS 3X7 21 SQ","code_information":[{"code":"12632","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.18,"discounted_cash":17.09,"setting":"both","billing_class":"facility"}]},{"description":"DSG OASIS 3.5X3 11SQ","code_information":[{"code":"12633","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.34,"discounted_cash":16.17,"setting":"both","billing_class":"facility"}]},{"description":"DSG OASIS 5X7 35 SQ","code_information":[{"code":"12634","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.21,"discounted_cash":17.61,"setting":"both","billing_class":"facility"}]},{"description":"DRAPE ALL G07","code_information":[{"code":"12641","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.55,"discounted_cash":28.77,"setting":"both","billing_class":"facility"}]},{"description":"DRAPE ALL G09","code_information":[{"code":"12643","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":74.15,"discounted_cash":37.08,"setting":"both","billing_class":"facility"}]},{"description":"DRAPE ALL G10","code_information":[{"code":"12644","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.25,"discounted_cash":41.13,"setting":"both","billing_class":"facility"}]},{"description":"DRAPE ALL G11","code_information":[{"code":"12645","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":40.13,"setting":"both","billing_class":"facility"}]},{"description":"DRAPE ALL G12","code_information":[{"code":"12646","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.65,"discounted_cash":43.83,"setting":"both","billing_class":"facility"}]},{"description":"DRAPE ALL G13","code_information":[{"code":"12647","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.65,"discounted_cash":47.33,"setting":"both","billing_class":"facility"}]},{"description":"DRAPE ALL G14","code_information":[{"code":"12648","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility"}]},{"description":"DRAPE ALL G15","code_information":[{"code":"12649","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.4,"discounted_cash":54.7,"setting":"both","billing_class":"facility"}]},{"description":"DRAPE ALL G17","code_information":[{"code":"12651","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.05,"discounted_cash":62.02,"setting":"both","billing_class":"facility"}]},{"description":"DRAPE ALL G18","code_information":[{"code":"12652","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":131.15,"discounted_cash":65.58,"setting":"both","billing_class":"facility"}]},{"description":"DRAPE ALL G19","code_information":[{"code":"12653","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.55,"discounted_cash":69.28,"setting":"both","billing_class":"facility"}]},{"description":"PACK TX-BONE PROCED","code_information":[{"code":"12655","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3373.65,"discounted_cash":1686.83,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G01","code_information":[{"code":"12658","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":12.63,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G02","code_information":[{"code":"12659","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.45,"discounted_cash":12.72,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G11","code_information":[{"code":"12660","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":40.13,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G12","code_information":[{"code":"12661","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.65,"discounted_cash":43.83,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G13","code_information":[{"code":"12662","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.65,"discounted_cash":47.33,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G14","code_information":[{"code":"12663","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":101.9,"discounted_cash":50.95,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G15","code_information":[{"code":"12664","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.4,"discounted_cash":54.7,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G16","code_information":[{"code":"12665","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.75,"discounted_cash":58.38,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G17","code_information":[{"code":"12666","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.05,"discounted_cash":62.02,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G18","code_information":[{"code":"12667","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":131.15,"discounted_cash":65.58,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G19","code_information":[{"code":"12668","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.55,"discounted_cash":69.28,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G20","code_information":[{"code":"12669","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":145.9,"discounted_cash":72.95,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G21","code_information":[{"code":"12670","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":182.35,"discounted_cash":91.17,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G22","code_information":[{"code":"12671","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":211.35,"discounted_cash":105.67,"setting":"both","billing_class":"facility"}]},{"description":"FILTER G03","code_information":[{"code":"12673","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":12.63,"setting":"both","billing_class":"facility"}]},{"description":"FILTER G08","code_information":[{"code":"12674","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.15,"discounted_cash":32.08,"setting":"both","billing_class":"facility"}]},{"description":"CATH TA NONLAS G28","code_information":[{"code":"12675","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":645.13,"discounted_cash":322.56,"setting":"both","billing_class":"facility"}]},{"description":"CATH TA NONLAS G29","code_information":[{"code":"12676","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":806.37,"discounted_cash":403.19,"setting":"both","billing_class":"facility"}]},{"description":"CATH NONLAS G30","code_information":[{"code":"12677","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":879.68,"discounted_cash":439.84,"setting":"both","billing_class":"facility"}]},{"description":"CATH TA NONLAS G31","code_information":[{"code":"12678","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1026.35,"discounted_cash":513.17,"setting":"both","billing_class":"facility"}]},{"description":"CATH TA NONLAS G32","code_information":[{"code":"12679","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1172.96,"discounted_cash":586.48,"setting":"both","billing_class":"facility"}]},{"description":"CATH TA NONLAS G33","code_information":[{"code":"12680","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.57,"discounted_cash":692.78,"setting":"both","billing_class":"facility"}]},{"description":"CATH TA NONLAS G34","code_information":[{"code":"12681","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1396.9,"discounted_cash":698.45,"setting":"both","billing_class":"facility"}]},{"description":"CATH TA NONLAS G35","code_information":[{"code":"12682","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.51,"discounted_cash":808.25,"setting":"both","billing_class":"facility"}]},{"description":"CATH TA NON LAS","code_information":[{"code":"12683","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2052.69,"discounted_cash":1026.35,"setting":"both","billing_class":"facility"}]},{"description":"CATH TA NONLAS G41","code_information":[{"code":"12684","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":4398.67,"discounted_cash":2199.34,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLLN G25","code_information":[{"code":"12686","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":316.74,"discounted_cash":158.37,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLLN G27","code_information":[{"code":"12688","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.84,"discounted_cash":241.92,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLLN G28","code_information":[{"code":"12689","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":645.13,"discounted_cash":322.56,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLLN G29","code_information":[{"code":"12690","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":806.37,"discounted_cash":403.19,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLLN G30","code_information":[{"code":"12691","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":879.68,"discounted_cash":439.84,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLLN G34","code_information":[{"code":"12695","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1466.19,"discounted_cash":733.1,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLLN G35","code_information":[{"code":"12696","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.49,"discounted_cash":769.75,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLLN G38","code_information":[{"code":"12699","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2309.29,"discounted_cash":1154.64,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLLN G39","code_information":[{"code":"12700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2565.79,"discounted_cash":1282.89,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLLN G40","code_information":[{"code":"12701","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3299.01,"discounted_cash":1649.51,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLLN G41","code_information":[{"code":"12702","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":4398.67,"discounted_cash":2199.34,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G18","code_information":[{"code":"12703","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.9,"discounted_cash":65.45,"setting":"both","billing_class":"facility"}]},{"description":"KITS G01","code_information":[{"code":"12706","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":12.63,"setting":"both","billing_class":"facility"}]},{"description":"KITS G04","code_information":[{"code":"12707","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":16.88,"setting":"both","billing_class":"facility"}]},{"description":"KITS G05","code_information":[{"code":"12708","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":21.2,"setting":"both","billing_class":"facility"}]},{"description":"KITS G06","code_information":[{"code":"12709","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.1,"discounted_cash":23.55,"setting":"both","billing_class":"facility"}]},{"description":"KITS G07","code_information":[{"code":"12710","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.8,"discounted_cash":27.4,"setting":"both","billing_class":"facility"}]},{"description":"KITS G10","code_information":[{"code":"12711","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":39.38,"setting":"both","billing_class":"facility"}]},{"description":"KIT G15","code_information":[{"code":"12712","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.4,"discounted_cash":54.7,"setting":"both","billing_class":"facility"}]},{"description":"KITS G18","code_information":[{"code":"12713","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":65.5,"setting":"both","billing_class":"facility"}]},{"description":"KITS G19","code_information":[{"code":"12714","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.55,"discounted_cash":69.28,"setting":"both","billing_class":"facility"}]},{"description":"KITS G20","code_information":[{"code":"12715","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":145.9,"discounted_cash":72.95,"setting":"both","billing_class":"facility"}]},{"description":"KITS G22","code_information":[{"code":"12717","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.05,"discounted_cash":101.03,"setting":"both","billing_class":"facility"}]},{"description":"KITS G23","code_information":[{"code":"12718","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.25,"discounted_cash":117.63,"setting":"both","billing_class":"facility"}]},{"description":"KITS G24","code_information":[{"code":"12719","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":269.2,"discounted_cash":134.6,"setting":"both","billing_class":"facility"}]},{"description":"KITS G25","code_information":[{"code":"12720","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.05,"discounted_cash":151.53,"setting":"both","billing_class":"facility"}]},{"description":"KIT G26","code_information":[{"code":"12721","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.8,"discounted_cash":168.4,"setting":"both","billing_class":"facility"}]},{"description":"KITS G27","code_information":[{"code":"12722","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":231.5,"setting":"both","billing_class":"facility"}]},{"description":"KITS G28","code_information":[{"code":"12723","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":617.2,"discounted_cash":308.6,"setting":"both","billing_class":"facility"}]},{"description":"KITS G29","code_information":[{"code":"12724","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":771.85,"discounted_cash":385.93,"setting":"both","billing_class":"facility"}]},{"description":"KITS G30","code_information":[{"code":"12725","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":842.15,"discounted_cash":421.07,"setting":"both","billing_class":"facility"}]},{"description":"KITS G31","code_information":[{"code":"12726","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":982.15,"discounted_cash":491.07,"setting":"both","billing_class":"facility"}]},{"description":"KITS G35","code_information":[{"code":"12730","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1473.2,"discounted_cash":736.6,"setting":"both","billing_class":"facility"}]},{"description":"KITS G37","code_information":[{"code":"12732","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1964.3,"discounted_cash":982.15,"setting":"both","billing_class":"facility"}]},{"description":"KITS G38","code_information":[{"code":"12733","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2209.85,"discounted_cash":1104.92,"setting":"both","billing_class":"facility"}]},{"description":"KITS G39","code_information":[{"code":"12734","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2455.3,"discounted_cash":1227.65,"setting":"both","billing_class":"facility"}]},{"description":"KITS G40","code_information":[{"code":"12735","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3156.95,"discounted_cash":1578.47,"setting":"both","billing_class":"facility"}]},{"description":"KITS G41","code_information":[{"code":"12736","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":4209.25,"discounted_cash":2104.63,"setting":"both","billing_class":"facility"}]},{"description":"KITS G42","code_information":[{"code":"12737","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5261.5,"discounted_cash":2630.75,"setting":"both","billing_class":"facility"}]},{"description":"KITS G43","code_information":[{"code":"12738","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":6507.9,"discounted_cash":3253.95,"setting":"both","billing_class":"facility"}]},{"description":"MICRO INTRODUCER 21G","code_information":[{"code":"12739","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":487.6,"discounted_cash":243.8,"setting":"both","billing_class":"facility"}]},{"description":"CATHETER FEMALE URIN","code_information":[{"code":"12740","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":28.15,"discounted_cash":14.07,"setting":"both","billing_class":"facility"}]},{"description":"GLIDESCOPE LOPRO 2","code_information":[{"code":"12741","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":148.15,"discounted_cash":74.08,"setting":"both","billing_class":"facility"}]},{"description":"GLIDESCOPE LOPRO 3","code_information":[{"code":"12742","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":123.65,"discounted_cash":61.83,"setting":"both","billing_class":"facility"}]},{"description":"SYSTM TRNSCROTID NEU","code_information":[{"code":"12743","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":6744.53,"discounted_cash":3372.26,"setting":"both","billing_class":"facility"}]},{"description":"STAPLER 28MM 3 ROW","code_information":[{"code":"12744","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2078.3,"discounted_cash":1039.15,"setting":"both","billing_class":"facility"}]},{"description":"MATRIX STRAVIX 2X4 8","code_information":[{"code":"12745","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":823.64,"discounted_cash":411.82,"setting":"both","billing_class":"facility"}]},{"description":"MATRIXSTRAVIX 3X6 18","code_information":[{"code":"12746","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.38,"discounted_cash":290.69,"setting":"both","billing_class":"facility"}]},{"description":"CATH ANGIO KMP","code_information":[{"code":"12747","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":56.35,"discounted_cash":28.18,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING BER","code_information":[{"code":"12748","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.99,"discounted_cash":19.0,"setting":"both","billing_class":"facility"}]},{"description":"PIN GUIDING .125X2.5","code_information":[{"code":"12749","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":785.4,"discounted_cash":392.7,"setting":"both","billing_class":"facility"}]},{"description":"MATRIX STRAVIX 2X2","code_information":[{"code":"12750","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":978.98,"discounted_cash":489.49,"setting":"both","billing_class":"facility"}]},{"description":"ALLOGRAFT TISSUE","code_information":[{"code":"12751","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":6927.88,"discounted_cash":3463.94,"setting":"both","billing_class":"facility"}]},{"description":"URTEROSCPE LITHO DSP","code_information":[{"code":"12752","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2727.05,"discounted_cash":1363.53,"setting":"both","billing_class":"facility"}]},{"description":"FIBER LSER MOSES 200","code_information":[{"code":"12753","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1104.75,"discounted_cash":552.38,"setting":"both","billing_class":"facility"}]},{"description":"FIBER LSR MOSES 365","code_information":[{"code":"12754","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":867.8,"discounted_cash":433.9,"setting":"both","billing_class":"facility"}]},{"description":"FIBER LSR MOSES 550","code_information":[{"code":"12755","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1183.5,"discounted_cash":591.75,"setting":"both","billing_class":"facility"}]},{"description":"FIBER LSR FLEXIVA200","code_information":[{"code":"12756","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":809.65,"discounted_cash":404.82,"setting":"both","billing_class":"facility"}]},{"description":"FIBER LSR FLEXIVA365","code_information":[{"code":"12757","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.1,"discounted_cash":337.55,"setting":"both","billing_class":"facility"}]},{"description":"FIBER LSR FLEXIVA550","code_information":[{"code":"12758","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":885.05,"discounted_cash":442.52,"setting":"both","billing_class":"facility"}]},{"description":"VIVIGEN CELLAR BONE","code_information":[{"code":"12759","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1081.7,"discounted_cash":540.85,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE LINX SIZING","code_information":[{"code":"12760","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":399.95,"discounted_cash":199.97,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE GELPORT TAMIS","code_information":[{"code":"12761","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1855.9,"discounted_cash":927.95,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE GELPORT ADVAN","code_information":[{"code":"12762","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1431.65,"discounted_cash":715.83,"setting":"both","billing_class":"facility"}]},{"description":"FIBER XPEEDA PROSTAT","code_information":[{"code":"12763","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1943.8,"discounted_cash":971.9,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G01","code_information":[{"code":"12764","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G02","code_information":[{"code":"12765","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.95,"discounted_cash":8.47,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G03","code_information":[{"code":"12766","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":13.0,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G05","code_information":[{"code":"12768","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":21.2,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G07","code_information":[{"code":"12770","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.8,"discounted_cash":27.4,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G08","code_information":[{"code":"12771","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.9,"discounted_cash":31.45,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G09","code_information":[{"code":"12772","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.5,"discounted_cash":35.25,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G10","code_information":[{"code":"12773","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.8,"discounted_cash":47.4,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G11","code_information":[{"code":"12774","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.3,"discounted_cash":42.15,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G14","code_information":[{"code":"12777","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.15,"discounted_cash":53.58,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G21","code_information":[{"code":"12780","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":182.05,"discounted_cash":91.03,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G23","code_information":[{"code":"12781","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.15,"discounted_cash":117.58,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G27","code_information":[{"code":"12782","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":231.5,"setting":"both","billing_class":"facility"}]},{"description":"NEELDES G32","code_information":[{"code":"12783","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1122.45,"discounted_cash":561.23,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G34","code_information":[{"code":"12784","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.05,"discounted_cash":701.52,"setting":"both","billing_class":"facility"}]},{"description":"OSTOMY SUPLY ALL G01","code_information":[{"code":"12785","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility"}]},{"description":"OSTOMY SUPLY ALL G02","code_information":[{"code":"12786","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.85,"discounted_cash":8.43,"setting":"both","billing_class":"facility"}]},{"description":"OSTOMY SUPLY ALL G03","code_information":[{"code":"12787","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.4,"discounted_cash":13.2,"setting":"both","billing_class":"facility"}]},{"description":"OSTOMY SUPLY ALL G04","code_information":[{"code":"12788","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.9,"discounted_cash":16.95,"setting":"both","billing_class":"facility"}]},{"description":"OSTOMY SUPLY ALL G05","code_information":[{"code":"12789","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":21.02,"setting":"both","billing_class":"facility"}]},{"description":"OSTOMY SUPLY ALL G06","code_information":[{"code":"12790","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.15,"discounted_cash":24.07,"setting":"both","billing_class":"facility"}]},{"description":"OSTOMY SUPLY ALL G07","code_information":[{"code":"12791","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":27.5,"setting":"both","billing_class":"facility"}]},{"description":"OSTOMY SUPLY ALL G08","code_information":[{"code":"12792","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.8,"discounted_cash":31.4,"setting":"both","billing_class":"facility"}]},{"description":"OSTOMY SUPLY ALL G09","code_information":[{"code":"12793","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.8,"discounted_cash":35.4,"setting":"both","billing_class":"facility"}]},{"description":"OSTOMY SUPLY ALL G10","code_information":[{"code":"12794","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.6,"discounted_cash":39.3,"setting":"both","billing_class":"facility"}]},{"description":"OSTOMY SUPLY ALL G11","code_information":[{"code":"12795","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":40.13,"setting":"both","billing_class":"facility"}]},{"description":"OSTOMY SUPLY ALL G12","code_information":[{"code":"12796","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.65,"discounted_cash":43.83,"setting":"both","billing_class":"facility"}]},{"description":"OSTOMY SUPLY ALL G13","code_information":[{"code":"12797","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.65,"discounted_cash":47.33,"setting":"both","billing_class":"facility"}]},{"description":"OSTOMY SUPLY ALL G14","code_information":[{"code":"12798","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility"}]},{"description":"PRIMATRIX 4X4 16 SQ","code_information":[{"code":"12799","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.32,"discounted_cash":75.66,"setting":"both","billing_class":"facility"}]},{"description":"PRIMATRIX 8X8 64 SQ","code_information":[{"code":"12800","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":117.93,"discounted_cash":58.97,"setting":"both","billing_class":"facility"}]},{"description":"PACK G09 RANGE 16-18","code_information":[{"code":"12801","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":68.95,"discounted_cash":34.48,"setting":"both","billing_class":"facility"}]},{"description":"PACK G10 RANGE 18-20","code_information":[{"code":"12802","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":74.85,"discounted_cash":37.42,"setting":"both","billing_class":"facility"}]},{"description":"PACK G11 RANGE 20-22","code_information":[{"code":"12803","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.35,"discounted_cash":38.17,"setting":"both","billing_class":"facility"}]},{"description":"PACK G12 RANGE 22-24","code_information":[{"code":"12804","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.5,"discounted_cash":41.75,"setting":"both","billing_class":"facility"}]},{"description":"PACK G13 RANGE 24-26","code_information":[{"code":"12805","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":90.15,"discounted_cash":45.08,"setting":"both","billing_class":"facility"}]},{"description":"PACK G14 RANGE 26-28","code_information":[{"code":"12806","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":97.15,"discounted_cash":48.58,"setting":"both","billing_class":"facility"}]},{"description":"PACK G15 RANGE 28-30","code_information":[{"code":"12807","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.35,"discounted_cash":53.17,"setting":"both","billing_class":"facility"}]},{"description":"PACK G16 RANGE 30-32","code_information":[{"code":"12808","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":115.6,"discounted_cash":57.8,"setting":"both","billing_class":"facility"}]},{"description":"PACK G17 RANGE 32-34","code_information":[{"code":"12809","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":118.15,"discounted_cash":59.08,"setting":"both","billing_class":"facility"}]},{"description":"PACK G18 RANGE 34-36","code_information":[{"code":"12810","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.85,"discounted_cash":62.42,"setting":"both","billing_class":"facility"}]},{"description":"PACK G19 RANGE 36-38","code_information":[{"code":"12811","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":117.4,"discounted_cash":58.7,"setting":"both","billing_class":"facility"}]},{"description":"PACK G20 RANGE 38-40","code_information":[{"code":"12812","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.95,"discounted_cash":69.47,"setting":"both","billing_class":"facility"}]},{"description":"PACK G21 RANGE 40-50","code_information":[{"code":"12813","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.45,"discounted_cash":86.72,"setting":"both","billing_class":"facility"}]},{"description":"PACK G22 RANGE 50-60","code_information":[{"code":"12814","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":192.55,"discounted_cash":96.28,"setting":"both","billing_class":"facility"}]},{"description":"PACK G23 RANGE 60-70","code_information":[{"code":"12815","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.3,"discounted_cash":112.15,"setting":"both","billing_class":"facility"}]},{"description":"PACK G24 RANGE 70-80","code_information":[{"code":"12816","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.75,"discounted_cash":128.38,"setting":"both","billing_class":"facility"}]},{"description":"PACK G25 RANGE 80-90","code_information":[{"code":"12817","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":288.65,"discounted_cash":144.32,"setting":"both","billing_class":"facility"}]},{"description":"PAC G26 RANGE 90-100","code_information":[{"code":"12818","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":320.95,"discounted_cash":160.47,"setting":"both","billing_class":"facility"}]},{"description":"PAC G27 RANG 100-150","code_information":[{"code":"12819","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":441.05,"discounted_cash":220.53,"setting":"both","billing_class":"facility"}]},{"description":"PAC G28 RANG 150-200","code_information":[{"code":"12820","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.95,"discounted_cash":293.98,"setting":"both","billing_class":"facility"}]},{"description":"PACKS G29","code_information":[{"code":"12821","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":734.9,"discounted_cash":367.45,"setting":"both","billing_class":"facility"}]},{"description":"PAC G30 RANG 250-300","code_information":[{"code":"12822","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.1,"discounted_cash":401.05,"setting":"both","billing_class":"facility"}]},{"description":"PAC G31 RANG 300-350","code_information":[{"code":"12823","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":958.45,"discounted_cash":479.23,"setting":"both","billing_class":"facility"}]},{"description":"PAC G33 RANG 400-450","code_information":[{"code":"12824","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1202.6,"discounted_cash":601.3,"setting":"both","billing_class":"facility"}]},{"description":"PAD GROUNDING ADULT","code_information":[{"code":"12826","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.05,"discounted_cash":12.03,"setting":"both","billing_class":"facility"}]},{"description":"PAD GROUNDING ADULT","code_information":[{"code":"12827","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility"}]},{"description":"PAD GROUNDING ADULT","code_information":[{"code":"12828","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":40.05,"discounted_cash":20.02,"setting":"both","billing_class":"facility"}]},{"description":"PAD GROUNDING ADULT","code_information":[{"code":"12829","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.4,"discounted_cash":26.2,"setting":"both","billing_class":"facility"}]},{"description":"PAD GROUNDING ADULT","code_information":[{"code":"12831","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":67.45,"discounted_cash":33.73,"setting":"both","billing_class":"facility"}]},{"description":"PAD GROUNDING G09","code_information":[{"code":"12832","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.8,"discounted_cash":35.4,"setting":"both","billing_class":"facility"}]},{"description":"PAD GROUNDING G10","code_information":[{"code":"12833","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.6,"discounted_cash":39.3,"setting":"both","billing_class":"facility"}]},{"description":"PAD GROUNDING G11","code_information":[{"code":"12834","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":40.13,"setting":"both","billing_class":"facility"}]},{"description":"PAD GROUNDING G12","code_information":[{"code":"12835","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.65,"discounted_cash":43.83,"setting":"both","billing_class":"facility"}]},{"description":"SYSTM WOUND VAC W CN","code_information":[{"code":"12836","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.85,"discounted_cash":42.42,"setting":"both","billing_class":"facility"}]},{"description":"SYSTM PREVENA INCS M","code_information":[{"code":"12837","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":935.95,"discounted_cash":467.98,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM PREVENA 45ML","code_information":[{"code":"12838","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.7,"discounted_cash":36.35,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM PREVENA PLUS","code_information":[{"code":"12839","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.95,"discounted_cash":31.98,"setting":"both","billing_class":"facility"}]},{"description":"KIT PREVENA PLUS","code_information":[{"code":"12840","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1075.35,"discounted_cash":537.67,"setting":"both","billing_class":"facility"}]},{"description":"POWDER HEMOSTATIC","code_information":[{"code":"12841","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":460.25,"discounted_cash":230.13,"setting":"both","billing_class":"facility"}]},{"description":"APPLCTR SURGCEL PWD","code_information":[{"code":"12842","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.9,"discounted_cash":28.95,"setting":"both","billing_class":"facility"}]},{"description":"WOUND CROWN 380X380","code_information":[{"code":"12843","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility"}]},{"description":"FISTULA FUNNEL 380X3","code_information":[{"code":"12844","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":330.85,"discounted_cash":165.43,"setting":"both","billing_class":"facility"}]},{"description":"STRIP ISOLATOR 380X3","code_information":[{"code":"12845","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":351.5,"discounted_cash":175.75,"setting":"both","billing_class":"facility"}]},{"description":"TRU CORE BIOPSY KIT","code_information":[{"code":"12846","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":81.2,"discounted_cash":40.6,"setting":"both","billing_class":"facility"}]},{"description":"CO AXIAL INTRODUCER","code_information":[{"code":"12847","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.6,"discounted_cash":15.3,"setting":"both","billing_class":"facility"}]},{"description":"KIT PNE","code_information":[{"code":"12848","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.4,"discounted_cash":202.7,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX PRIME PER SQ","code_information":[{"code":"12849","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":429.22,"discounted_cash":214.61,"setting":"both","billing_class":"facility"}]},{"description":"PINS/WIRES/CAPS G27","code_information":[{"code":"12850","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":231.5,"setting":"both","billing_class":"facility"}]},{"description":"RESUSCITATOR ADULT","code_information":[{"code":"12851","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.05,"discounted_cash":20.52,"setting":"both","billing_class":"facility"}]},{"description":"RESUSCITATOR PEDI","code_information":[{"code":"12852","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.35,"discounted_cash":17.18,"setting":"both","billing_class":"facility"}]},{"description":"PENILE RETRACTOR KIT","code_information":[{"code":"12853","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":684.6,"discounted_cash":342.3,"setting":"both","billing_class":"facility"}]},{"description":"PROBE ANY G27","code_information":[{"code":"12854","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":484.35,"discounted_cash":242.18,"setting":"both","billing_class":"facility"}]},{"description":"AWL TAPERED 3.8 DISP","code_information":[{"code":"12855","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.4,"discounted_cash":89.7,"setting":"both","billing_class":"facility"}]},{"description":"PROBE ANY G35","code_information":[{"code":"12856","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1541.15,"discounted_cash":770.58,"setting":"both","billing_class":"facility"}]},{"description":"CONNECTOR SS PP","code_information":[{"code":"12857","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":659.3,"discounted_cash":329.65,"setting":"both","billing_class":"facility"}]},{"description":"RETRACTORS G21","code_information":[{"code":"12858","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":525.95,"discounted_cash":262.98,"setting":"both","billing_class":"facility"}]},{"description":"RETRACTORS G23","code_information":[{"code":"12859","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.15,"discounted_cash":117.58,"setting":"both","billing_class":"facility"}]},{"description":"RETRACTORS G24","code_information":[{"code":"12860","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":269.45,"discounted_cash":134.72,"setting":"both","billing_class":"facility"}]},{"description":"RETRIEVER G27","code_information":[{"code":"12861","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.8,"discounted_cash":168.4,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G23","code_information":[{"code":"12862","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.35,"discounted_cash":117.67,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G24","code_information":[{"code":"12863","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":269.45,"discounted_cash":134.72,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G25","code_information":[{"code":"12864","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":309.4,"discounted_cash":154.7,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G26","code_information":[{"code":"12865","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.8,"discounted_cash":168.4,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G27","code_information":[{"code":"12866","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":231.5,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G28","code_information":[{"code":"12867","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":616.9,"discounted_cash":308.45,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G29","code_information":[{"code":"12868","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":771.65,"discounted_cash":385.82,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G30","code_information":[{"code":"12869","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":841.8,"discounted_cash":420.9,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G31","code_information":[{"code":"12870","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":981.75,"discounted_cash":490.88,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G32","code_information":[{"code":"12871","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1122.4,"discounted_cash":561.2,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G33","code_information":[{"code":"12872","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1262.85,"discounted_cash":631.42,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G34","code_information":[{"code":"12873","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.05,"discounted_cash":701.52,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G35","code_information":[{"code":"12874","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1473.5,"discounted_cash":736.75,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G36","code_information":[{"code":"12875","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1718.7,"discounted_cash":859.35,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G39","code_information":[{"code":"12878","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2812.8,"discounted_cash":1406.4,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G41","code_information":[{"code":"12880","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":4209.25,"discounted_cash":2104.63,"setting":"both","billing_class":"facility"}]},{"description":"ENDO DEVICE G42","code_information":[{"code":"12881","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5261.5,"discounted_cash":2630.75,"setting":"both","billing_class":"facility"}]},{"description":"SETS G01","code_information":[{"code":"12882","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":4.25,"setting":"both","billing_class":"facility"}]},{"description":"SETS G02","code_information":[{"code":"12883","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.85,"discounted_cash":8.43,"setting":"both","billing_class":"facility"}]},{"description":"SETS G03","code_information":[{"code":"12884","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.3,"discounted_cash":12.65,"setting":"both","billing_class":"facility"}]},{"description":"SETS G04","code_information":[{"code":"12885","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.8,"discounted_cash":16.9,"setting":"both","billing_class":"facility"}]},{"description":"SETS G05","code_information":[{"code":"12886","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":21.2,"setting":"both","billing_class":"facility"}]},{"description":"SETS G06","code_information":[{"code":"12887","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.1,"discounted_cash":24.55,"setting":"both","billing_class":"facility"}]},{"description":"SETS G07","code_information":[{"code":"12888","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.75,"discounted_cash":27.38,"setting":"both","billing_class":"facility"}]},{"description":"SETS G08","code_information":[{"code":"12889","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.8,"discounted_cash":31.4,"setting":"both","billing_class":"facility"}]},{"description":"SETS G09","code_information":[{"code":"12890","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.8,"discounted_cash":35.4,"setting":"both","billing_class":"facility"}]},{"description":"SETS G10","code_information":[{"code":"12891","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.65,"discounted_cash":39.33,"setting":"both","billing_class":"facility"}]},{"description":"SETS G11","code_information":[{"code":"12892","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":40.13,"setting":"both","billing_class":"facility"}]},{"description":"SETS G13","code_information":[{"code":"12894","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.65,"discounted_cash":47.33,"setting":"both","billing_class":"facility"}]},{"description":"SETS G16","code_information":[{"code":"12897","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.75,"discounted_cash":58.38,"setting":"both","billing_class":"facility"}]},{"description":"SETS G17","code_information":[{"code":"12898","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.05,"discounted_cash":62.02,"setting":"both","billing_class":"facility"}]},{"description":"SETS G18","code_information":[{"code":"12899","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.9,"discounted_cash":65.45,"setting":"both","billing_class":"facility"}]},{"description":"SETS G19","code_information":[{"code":"12900","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.4,"discounted_cash":69.2,"setting":"both","billing_class":"facility"}]},{"description":"SETS G20","code_information":[{"code":"12901","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":145.9,"discounted_cash":72.95,"setting":"both","billing_class":"facility"}]},{"description":"SETS G22","code_information":[{"code":"12903","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.3,"discounted_cash":101.15,"setting":"both","billing_class":"facility"}]},{"description":"SETS G25","code_information":[{"code":"12906","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.1,"discounted_cash":151.55,"setting":"both","billing_class":"facility"}]},{"description":"SETS G27","code_information":[{"code":"12908","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":231.5,"setting":"both","billing_class":"facility"}]},{"description":"SETS G28","code_information":[{"code":"12909","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":617.35,"discounted_cash":308.68,"setting":"both","billing_class":"facility"}]},{"description":"SETS G29","code_information":[{"code":"12910","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":771.65,"discounted_cash":385.82,"setting":"both","billing_class":"facility"}]},{"description":"SHEATHS/COVERS G06","code_information":[{"code":"12913","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.11,"discounted_cash":25.05,"setting":"both","billing_class":"facility"}]},{"description":"SHEATHS/COVERS G22","code_information":[{"code":"12916","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.05,"discounted_cash":101.03,"setting":"both","billing_class":"facility"}]},{"description":"SHEATHS/COVERS G23","code_information":[{"code":"12917","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.7,"discounted_cash":117.85,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH/COVER G25","code_information":[{"code":"12918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":316.74,"discounted_cash":158.37,"setting":"both","billing_class":"facility"}]},{"description":"SHEATHS/COVERS G27","code_information":[{"code":"12920","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":440.95,"discounted_cash":220.47,"setting":"both","billing_class":"facility"}]},{"description":"SHEATHS/COVERS G30","code_information":[{"code":"12921","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":880.6,"discounted_cash":440.3,"setting":"both","billing_class":"facility"}]},{"description":"SHEATHS/COVERS G31","code_information":[{"code":"12922","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":982.15,"discounted_cash":491.07,"setting":"both","billing_class":"facility"}]},{"description":"SHEATHS/COVERS G33","code_information":[{"code":"12923","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1206.35,"discounted_cash":603.17,"setting":"both","billing_class":"facility"}]},{"description":"SHEATHS/COVERS G35","code_information":[{"code":"12924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1540.17,"discounted_cash":770.09,"setting":"both","billing_class":"facility"}]},{"description":"SHEATHS/COVERS G33","code_information":[{"code":"12925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1172.96,"discounted_cash":586.48,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVES G07","code_information":[{"code":"12926","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.75,"discounted_cash":27.38,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVES G09","code_information":[{"code":"12927","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.15,"discounted_cash":36.08,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVES G10","code_information":[{"code":"12928","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":39.38,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVES G11","code_information":[{"code":"12929","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.15,"discounted_cash":40.08,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVES G13","code_information":[{"code":"12930","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.6,"discounted_cash":47.3,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVES G14","code_information":[{"code":"12931","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":101.9,"discounted_cash":50.95,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVES G18","code_information":[{"code":"12932","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":65.5,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVES G19","code_information":[{"code":"12933","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.55,"discounted_cash":69.28,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX 1.5CMX2CM-3SQ","code_information":[{"code":"12935","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4132","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":768.03,"discounted_cash":384.01,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX 2CMX3CM-6SQCM","code_information":[{"code":"12936","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4132","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":578.87,"discounted_cash":289.44,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX PR1.5X2 3SQCM","code_information":[{"code":"12937","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":971.5,"discounted_cash":485.75,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX PR 2X3 6SQ CM","code_information":[{"code":"12938","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":668.35,"discounted_cash":334.18,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX PR 3X4 12SQCM","code_information":[{"code":"12939","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":409.95,"discounted_cash":204.97,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX PRME 16MM 2SQ","code_information":[{"code":"12940","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":822.41,"discounted_cash":411.2,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX PRME 3 CM 9SQ","code_information":[{"code":"12941","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":505.63,"discounted_cash":252.81,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX PRME 5CM 25SQ","code_information":[{"code":"12942","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":418.66,"discounted_cash":209.33,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX XC 7.5X15 113","code_information":[{"code":"12943","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":293.15,"discounted_cash":146.57,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX CORE 3X4 12SQ","code_information":[{"code":"12944","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":212.43,"discounted_cash":106.22,"setting":"both","billing_class":"facility"}]},{"description":"SPLINTS G23","code_information":[{"code":"12945","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.65,"discounted_cash":117.83,"setting":"both","billing_class":"facility"}]},{"description":"CUFF TOURNQT ADLT 12","code_information":[{"code":"12946","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":129.7,"discounted_cash":64.85,"setting":"both","billing_class":"facility"}]},{"description":"STENTS G27","code_information":[{"code":"12949","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.84,"discounted_cash":241.92,"setting":"both","billing_class":"facility"}]},{"description":"STAPLE/STAPLER G21","code_information":[{"code":"12960","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":182.15,"discounted_cash":91.08,"setting":"both","billing_class":"facility"}]},{"description":"STAPLE/STAPLER G23","code_information":[{"code":"12962","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.55,"discounted_cash":117.78,"setting":"both","billing_class":"facility"}]},{"description":"STAPLE/STAPLER G25","code_information":[{"code":"12964","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.1,"discounted_cash":151.55,"setting":"both","billing_class":"facility"}]},{"description":"STAPLE/STAPLER G26","code_information":[{"code":"12965","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.8,"discounted_cash":168.4,"setting":"both","billing_class":"facility"}]},{"description":"STAPLE/STAPLER G27","code_information":[{"code":"12966","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":231.5,"setting":"both","billing_class":"facility"}]},{"description":"STAPLE/STAPLER G28","code_information":[{"code":"12967","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":617.2,"discounted_cash":308.6,"setting":"both","billing_class":"facility"}]},{"description":"STAPLE/STAPLER G29","code_information":[{"code":"12968","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":771.75,"discounted_cash":385.88,"setting":"both","billing_class":"facility"}]},{"description":"STAPLE/STAPLER G30","code_information":[{"code":"12969","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":842.05,"discounted_cash":421.02,"setting":"both","billing_class":"facility"}]},{"description":"STAPLE/STAPLER G31","code_information":[{"code":"12970","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":981.95,"discounted_cash":490.98,"setting":"both","billing_class":"facility"}]},{"description":"STAPLE/STAPLER G32","code_information":[{"code":"12971","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1122.45,"discounted_cash":561.23,"setting":"both","billing_class":"facility"}]},{"description":"STAPLE/STAPLER G35","code_information":[{"code":"12974","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1473.2,"discounted_cash":736.6,"setting":"both","billing_class":"facility"}]},{"description":"STAPLE/STAPLER G37","code_information":[{"code":"12976","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2361.85,"discounted_cash":1180.92,"setting":"both","billing_class":"facility"}]},{"description":"CLARIX PEEL16 SQ CM","code_information":[{"code":"12978","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.61,"discounted_cash":187.81,"setting":"both","billing_class":"facility"}]},{"description":"SURGICAL SNOW 2X4","code_information":[{"code":"12979","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":372.05,"discounted_cash":186.03,"setting":"both","billing_class":"facility"}]},{"description":"NEO CORD 2.5X2.5 6SQ","code_information":[{"code":"12981","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":644.93,"discounted_cash":322.46,"setting":"both","billing_class":"facility"}]},{"description":"NEO CORD 4X3 12 SQ","code_information":[{"code":"12982","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4148","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":601.11,"discounted_cash":300.56,"setting":"both","billing_class":"facility"}]},{"description":"NEO CORD 6X3 18 SQ","code_information":[{"code":"12983","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4148","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":590.3,"discounted_cash":295.15,"setting":"both","billing_class":"facility"}]},{"description":"NEO CORD 8X3 24 SQ","code_information":[{"code":"12984","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4148","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":590.3,"discounted_cash":295.15,"setting":"both","billing_class":"facility"}]},{"description":"NEO CORD 2X2 4 SQ","code_information":[{"code":"12985","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":453.67,"discounted_cash":226.84,"setting":"both","billing_class":"facility"}]},{"description":"NEO CORD 4X4 16 SQ","code_information":[{"code":"12986","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":406.98,"discounted_cash":203.49,"setting":"both","billing_class":"facility"}]},{"description":"NEO CORD 7X7 49 SQ","code_information":[{"code":"12987","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":396.16,"discounted_cash":198.08,"setting":"both","billing_class":"facility"}]},{"description":"CLARIX CORD 6X3 18SQ","code_information":[{"code":"12988","type":"CDM"},{"code":"278","type":"RC"},{"code":"V2790","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":526.37,"discounted_cash":263.19,"setting":"both","billing_class":"facility"}]},{"description":"NEO CORD 1.5X1.5 2SQ","code_information":[{"code":"12989","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3397.62,"discounted_cash":1698.81,"setting":"both","billing_class":"facility"}]},{"description":"CLARIX CORD 6 SQ CM","code_information":[{"code":"12990","type":"CDM"},{"code":"278","type":"RC"},{"code":"V2790","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":920.23,"discounted_cash":460.12,"setting":"both","billing_class":"facility"}]},{"description":"NEO CORD 2.5X2.5 6SQ","code_information":[{"code":"12991","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4148","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":607.88,"discounted_cash":303.94,"setting":"both","billing_class":"facility"}]},{"description":"NEO CORD 3X3  9 SQ","code_information":[{"code":"12992","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4148","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":700.02,"discounted_cash":350.01,"setting":"both","billing_class":"facility"}]},{"description":"EPFIX ALLGRFT SQCM","code_information":[{"code":"12998","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4186","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":602.65,"discounted_cash":301.32,"setting":"both","billing_class":"facility"}]},{"description":"LVL 1 EST O/P VISIT","code_information":[{"code":"13","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":383.95,"discounted_cash":191.97,"setting":"both","billing_class":"facility"}]},{"description":"BALN DRUG COAT IN 60","code_information":[{"code":"13004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2623","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2972.35,"discounted_cash":1486.17,"setting":"both","billing_class":"facility"}]},{"description":"BALN DRUG COT IN 120","code_information":[{"code":"13005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2623","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3271.58,"discounted_cash":1635.79,"setting":"both","billing_class":"facility"}]},{"description":"BONE TAP 4.0-5.0","code_information":[{"code":"13006","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":533.3,"discounted_cash":266.65,"setting":"both","billing_class":"facility"}]},{"description":"BALN DRUG COTED LUTN","code_information":[{"code":"13012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2623","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3092.0,"discounted_cash":1546.0,"setting":"both","billing_class":"facility"}]},{"description":"BALN ULTRAVERSE","code_information":[{"code":"13013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":353.31,"discounted_cash":176.66,"setting":"both","billing_class":"facility"}]},{"description":"KEPHROPLASTY MIXER","code_information":[{"code":"13014","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":607.55,"discounted_cash":303.77,"setting":"both","billing_class":"facility"}]},{"description":"BALN DRUG COATED 130","code_information":[{"code":"13015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2623","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.81,"discounted_cash":1339.4,"setting":"both","billing_class":"facility"}]},{"description":"FIBER 1000 FORTEC","code_information":[{"code":"13016","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":637.25,"discounted_cash":318.63,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM PICO NP WCARE","code_information":[{"code":"13017","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":639.95,"discounted_cash":319.98,"setting":"both","billing_class":"facility"}]},{"description":"CUFF TOURNIQUET REPR","code_information":[{"code":"13018","type":"CDM"},{"code":"270","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.3,"discounted_cash":16.65,"setting":"both","billing_class":"facility"}]},{"description":"CABLE/EXT 1X16 NEURO","code_information":[{"code":"13019","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1336.25,"discounted_cash":668.13,"setting":"both","billing_class":"facility"}]},{"description":"SUPPORT ANY G23","code_information":[{"code":"13020","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":269.45,"discounted_cash":134.72,"setting":"both","billing_class":"facility"}]},{"description":"SURGICAL SNOW 4X4","code_information":[{"code":"13023","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":488.05,"discounted_cash":244.03,"setting":"both","billing_class":"facility"}]},{"description":"TIP SCISSOR HOOK","code_information":[{"code":"13024","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.6,"discounted_cash":101.3,"setting":"both","billing_class":"facility"}]},{"description":"TIP MOD RAPTOR GRASP","code_information":[{"code":"13025","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":212.5,"discounted_cash":106.25,"setting":"both","billing_class":"facility"}]},{"description":"TIP GRASPER DISP","code_information":[{"code":"13026","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":262.9,"discounted_cash":131.45,"setting":"both","billing_class":"facility"}]},{"description":"TIP MARYLAND FORCEP","code_information":[{"code":"13027","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":215.8,"discounted_cash":107.9,"setting":"both","billing_class":"facility"}]},{"description":"BLN CERVICAL DILATOR","code_information":[{"code":"13028","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":154.6,"discounted_cash":77.3,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G01","code_information":[{"code":"13029","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G02","code_information":[{"code":"13030","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.85,"discounted_cash":8.43,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G03","code_information":[{"code":"13031","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.4,"discounted_cash":12.7,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G04","code_information":[{"code":"13032","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.65,"discounted_cash":16.82,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G05","code_information":[{"code":"13033","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.15,"discounted_cash":21.07,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G06","code_information":[{"code":"13034","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":23.5,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G07","code_information":[{"code":"13035","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.75,"discounted_cash":27.38,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G08","code_information":[{"code":"13036","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.85,"discounted_cash":31.43,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G09","code_information":[{"code":"13037","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.8,"discounted_cash":35.4,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G10","code_information":[{"code":"13038","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.6,"discounted_cash":39.3,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G11","code_information":[{"code":"13039","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.95,"discounted_cash":41.98,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G12","code_information":[{"code":"13040","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.55,"discounted_cash":43.77,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G13","code_information":[{"code":"13041","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.6,"discounted_cash":47.3,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G14","code_information":[{"code":"13042","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":105.1,"discounted_cash":52.55,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G15","code_information":[{"code":"13043","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.4,"discounted_cash":54.7,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G16","code_information":[{"code":"13044","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.7,"discounted_cash":58.35,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G17","code_information":[{"code":"13045","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":123.9,"discounted_cash":61.95,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G18","code_information":[{"code":"13046","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":131.15,"discounted_cash":65.58,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G19","code_information":[{"code":"13047","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.55,"discounted_cash":69.28,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G20","code_information":[{"code":"13048","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":145.9,"discounted_cash":72.95,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G21","code_information":[{"code":"13049","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":182.2,"discounted_cash":91.1,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G22","code_information":[{"code":"13050","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.05,"discounted_cash":101.03,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G23","code_information":[{"code":"13051","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.65,"discounted_cash":117.83,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G24","code_information":[{"code":"13052","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":269.1,"discounted_cash":134.55,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G25","code_information":[{"code":"13053","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.1,"discounted_cash":151.55,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G26","code_information":[{"code":"13054","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.8,"discounted_cash":168.4,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G27","code_information":[{"code":"13055","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":231.5,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G28","code_information":[{"code":"13056","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":748.45,"discounted_cash":374.23,"setting":"both","billing_class":"facility"}]},{"description":"CATH INDIGO THROM 8F","code_information":[{"code":"13058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5604.6,"discounted_cash":2802.3,"setting":"both","billing_class":"facility"}]},{"description":"CATH INDIGO THROM C5","code_information":[{"code":"13059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2365.31,"discounted_cash":1182.65,"setting":"both","billing_class":"facility"}]},{"description":"CATH INDIGO THROM C6","code_information":[{"code":"13060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3704.73,"discounted_cash":1852.37,"setting":"both","billing_class":"facility"}]},{"description":"INDIGO SEPARATOR 5","code_information":[{"code":"13061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1695.62,"discounted_cash":847.81,"setting":"both","billing_class":"facility"}]},{"description":"INDIGO SEPARATOR 6","code_information":[{"code":"13062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2194.34,"discounted_cash":1097.17,"setting":"both","billing_class":"facility"}]},{"description":"INDIGO SEPARATOR 8","code_information":[{"code":"13063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3714.19,"discounted_cash":1857.1,"setting":"both","billing_class":"facility"}]},{"description":"CANISTER MAX","code_information":[{"code":"13064","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":884.8,"discounted_cash":442.4,"setting":"both","billing_class":"facility"}]},{"description":"TUBING ASPIRATION","code_information":[{"code":"13065","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1078.7,"discounted_cash":539.35,"setting":"both","billing_class":"facility"}]},{"description":"CATH D WITH TUBING","code_information":[{"code":"13066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5224.58,"discounted_cash":2612.29,"setting":"both","billing_class":"facility"}]},{"description":"INDIGO SEPARATOR D","code_information":[{"code":"13067","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3189.4,"discounted_cash":1594.7,"setting":"both","billing_class":"facility"}]},{"description":"CATH SUCTION ORAL","code_information":[{"code":"13068","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.65,"discounted_cash":1.83,"setting":"both","billing_class":"facility"}]},{"description":"CURRETTE 11G KYPHRO","code_information":[{"code":"13069","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1194.1,"discounted_cash":597.05,"setting":"both","billing_class":"facility"}]},{"description":"NEO CORD 2.0X2.0 4SQ","code_information":[{"code":"13070","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4148","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":570.36,"discounted_cash":285.18,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE REZUM DELIV","code_information":[{"code":"13071","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4148","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2320.25,"discounted_cash":1160.13,"setting":"both","billing_class":"facility"}]},{"description":"CTH HMO PERI LTM G46","code_information":[{"code":"13072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":10352.97,"discounted_cash":5176.48,"setting":"both","billing_class":"facility"}]},{"description":"PENCIL ELCTROSURGERY","code_information":[{"code":"13073","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":74.3,"discounted_cash":37.15,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE CAPIO SLIM","code_information":[{"code":"13074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2631","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1115.85,"discounted_cash":557.92,"setting":"both","billing_class":"facility"}]},{"description":"HEMOSTAT ARISTA 1GR","code_information":[{"code":"13075","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2631","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":280.7,"discounted_cash":140.35,"setting":"both","billing_class":"facility"}]},{"description":"HEMOSTAT ARISTA 3 GR","code_information":[{"code":"13076","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2631","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":572.75,"discounted_cash":286.38,"setting":"both","billing_class":"facility"}]},{"description":"KIT INK MARGINMAKER","code_information":[{"code":"13077","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2631","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":339.35,"discounted_cash":169.68,"setting":"both","billing_class":"facility"}]},{"description":"APPLICATOR ARISTA XL","code_information":[{"code":"13078","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2631","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility"}]},{"description":"CLARIX CORD 4X3 12SQ","code_information":[{"code":"13079","type":"CDM"},{"code":"278","type":"RC"},{"code":"V2790","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":738.71,"discounted_cash":369.36,"setting":"both","billing_class":"facility"}]},{"description":"PIN HALF 3X60 SHORT","code_information":[{"code":"13080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":619.79,"discounted_cash":309.89,"setting":"both","billing_class":"facility"}]},{"description":"WRENCH ALLEN 2.5MM","code_information":[{"code":"13081","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":228.2,"discounted_cash":114.1,"setting":"both","billing_class":"facility"}]},{"description":"INSERTER PIN DUALEND","code_information":[{"code":"13082","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1542.05,"discounted_cash":771.02,"setting":"both","billing_class":"facility"}]},{"description":"BELT GAIT 60IN","code_information":[{"code":"13083","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":6.75,"setting":"both","billing_class":"facility"}]},{"description":"BELT GAIT 72IN","code_information":[{"code":"13084","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.7,"discounted_cash":7.35,"setting":"both","billing_class":"facility"}]},{"description":"SPRAY SHUR CLEN 12OZ","code_information":[{"code":"13085","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":8.63,"setting":"both","billing_class":"facility"}]},{"description":"COAGULATOR SCTN 10FR","code_information":[{"code":"13086","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.35,"discounted_cash":18.18,"setting":"both","billing_class":"facility"}]},{"description":"KIT HAMMERTOE INSTRT","code_information":[{"code":"13087","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":530.55,"discounted_cash":265.27,"setting":"both","billing_class":"facility"}]},{"description":"SYSTM CALIBRATION 40","code_information":[{"code":"13089","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":452.05,"discounted_cash":226.03,"setting":"both","billing_class":"facility"}]},{"description":"KIT REVSION INTRSTIM","code_information":[{"code":"13090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1415.35,"discounted_cash":707.67,"setting":"both","billing_class":"facility"}]},{"description":"KIT PERCTAN INTRSTIM","code_information":[{"code":"13091","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1883","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":997.4,"discounted_cash":498.7,"setting":"both","billing_class":"facility"}]},{"description":"LEAD INTERSTIM TST","code_information":[{"code":"13092","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1883","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":243.6,"discounted_cash":121.8,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE CORE BPSY 14G","code_information":[{"code":"13093","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1883","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":222.5,"discounted_cash":111.25,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE CORE BPSY 12G","code_information":[{"code":"13094","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1883","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":315.4,"discounted_cash":157.7,"setting":"both","billing_class":"facility"}]},{"description":"CERIBELL HANDBAND","code_information":[{"code":"13095","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4649","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1228.45,"discounted_cash":614.23,"setting":"both","billing_class":"facility"}]},{"description":"PACKS G34  RANGE 450","code_information":[{"code":"13096","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4649","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1276.4,"discounted_cash":638.2,"setting":"both","billing_class":"facility"}]},{"description":"PACKS G 35 RANGE 500","code_information":[{"code":"13097","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4649","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1340.05,"discounted_cash":670.02,"setting":"both","billing_class":"facility"}]},{"description":"BALN POSTPARTUM BAKR","code_information":[{"code":"13098","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":746.29,"discounted_cash":373.14,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE INFLATION","code_information":[{"code":"13099","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility"}]},{"description":"CATH BALN DILATION 3","code_information":[{"code":"13100","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":394.7,"discounted_cash":197.35,"setting":"both","billing_class":"facility"}]},{"description":"INTRODUCER SUPRAPUBI","code_information":[{"code":"13101","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":554.8,"discounted_cash":277.4,"setting":"both","billing_class":"facility"}]},{"description":"TRAY STR DISP G09 16","code_information":[{"code":"13102","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.15,"discounted_cash":30.57,"setting":"both","billing_class":"facility"}]},{"description":"MATRIX STATICE 30X30","code_information":[{"code":"13103","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4130","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.03,"discounted_cash":62.02,"setting":"both","billing_class":"facility"}]},{"description":"CLAMP CIRCUMCISION D","code_information":[{"code":"13104","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4130","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":92.9,"discounted_cash":46.45,"setting":"both","billing_class":"facility"}]},{"description":"ASSRNCE HEMOCLIP 18M","code_information":[{"code":"13105","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4130","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.05,"discounted_cash":124.03,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLE ENDO INJ","code_information":[{"code":"13106","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4130","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility"}]},{"description":"FORCEP E-JAW BOX","code_information":[{"code":"13107","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4130","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.85,"discounted_cash":11.43,"setting":"both","billing_class":"facility"}]},{"description":"RETREIVER ENDOPOUCH","code_information":[{"code":"13108","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4130","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":92.65,"discounted_cash":46.33,"setting":"both","billing_class":"facility"}]},{"description":"VALVE SPEAKING","code_information":[{"code":"13109","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4130","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":39.25,"setting":"both","billing_class":"facility"}]},{"description":"PAIN PROCED INITL 30","code_information":[{"code":"13110","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":5598.38,"discounted_cash":2799.19,"setting":"both","billing_class":"facility"}]},{"description":"PAIN PROCED SUBSQ 15","code_information":[{"code":"13111","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2488.25,"discounted_cash":1244.13,"setting":"both","billing_class":"facility"}]},{"description":"EST VST LEVEL 1","code_information":[{"code":"13112","type":"CDM"},{"code":"511","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.5,"discounted_cash":113.75,"setting":"both","billing_class":"facility"}]},{"description":"NEW VST LEVEL 2","code_information":[{"code":"13113","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.47,"discounted_cash":147.74,"setting":"both","billing_class":"facility"}]},{"description":"NEW VST LEVEL 3","code_information":[{"code":"13114","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":388.79,"discounted_cash":194.4,"setting":"both","billing_class":"facility"}]},{"description":"NEW VST LEVEL 4","code_information":[{"code":"13115","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":475.53,"discounted_cash":237.76,"setting":"both","billing_class":"facility"}]},{"description":"NEW VST LEVEL 5","code_information":[{"code":"13116","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":650.67,"discounted_cash":325.33,"setting":"both","billing_class":"facility"}]},{"description":"EST VST LEVEL 3","code_information":[{"code":"13117","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":272.43,"discounted_cash":136.22,"setting":"both","billing_class":"facility"}]},{"description":"EST VST LEVEL 4","code_information":[{"code":"13118","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":358.59,"discounted_cash":179.29,"setting":"both","billing_class":"facility"}]},{"description":"EST VST LEVEL 5","code_information":[{"code":"13119","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.69,"discounted_cash":219.34,"setting":"both","billing_class":"facility"}]},{"description":"ELEC ALYS IMPLT NPGT","code_information":[{"code":"13120","type":"CDM"},{"code":"920","type":"RC"},{"code":"95972","type":"CPT"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":382.21,"discounted_cash":191.1,"setting":"both","billing_class":"facility"}]},{"description":"EST VST LEVEL 2","code_information":[{"code":"13121","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.47,"discounted_cash":147.74,"setting":"both","billing_class":"facility"}]},{"description":"SPIN/BRAIN PUMP REFL","code_information":[{"code":"13122","type":"CDM"},{"code":"940","type":"RC"},{"code":"95991","type":"CPT"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":872.9,"discounted_cash":436.45,"setting":"both","billing_class":"facility"}]},{"description":"MINOR PROCEDURE","code_information":[{"code":"13123","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2059.96,"discounted_cash":1029.98,"setting":"both","billing_class":"facility"}]},{"description":"ELEC ALYS IMPLT NPGT","code_information":[{"code":"13124","type":"CDM"},{"code":"920","type":"RC"},{"code":"95970","type":"CPT"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":426.57,"discounted_cash":213.28,"setting":"both","billing_class":"facility"}]},{"description":"REFILL&MAINTEN PUMP","code_information":[{"code":"13125","type":"CDM"},{"code":"940","type":"RC"},{"code":"95990","type":"CPT"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1038.8,"discounted_cash":519.4,"setting":"both","billing_class":"facility"}]},{"description":"IMPLANT NEUROELECTRO","code_information":[{"code":"13126","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":15650.55,"discounted_cash":7825.27,"setting":"both","billing_class":"facility"}]},{"description":"PRQ IMPLTJ NSTIM ELE","code_information":[{"code":"13127","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":15650.55,"discounted_cash":7825.27,"setting":"both","billing_class":"facility"}]},{"description":"FLUOROSCOPIC GUIDANC","code_information":[{"code":"13128","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"CPT"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":302.42,"discounted_cash":151.21,"setting":"both","billing_class":"facility"}]},{"description":"ECHO GUIDE FOR BIOPS","code_information":[{"code":"13129","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"CPT"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":302.42,"discounted_cash":151.21,"setting":"both","billing_class":"facility"}]},{"description":"DESTR LUMB FACET INJ","code_information":[{"code":"13130","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":5085.99,"discounted_cash":2542.99,"setting":"both","billing_class":"facility"}]},{"description":"NJX AA&/STRD PUDENDA","code_information":[{"code":"13131","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.82,"discounted_cash":1305.91,"setting":"both","billing_class":"facility"}]},{"description":"DESTR CERV/THOR FACE","code_information":[{"code":"13132","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":5085.99,"discounted_cash":2542.99,"setting":"both","billing_class":"facility"}]},{"description":"INJ TRIGGER PNT 1-2","code_information":[{"code":"13133","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":925.27,"discounted_cash":462.63,"setting":"both","billing_class":"facility"}]},{"description":"DEST L/S FCT JNT ADD","code_information":[{"code":"13134","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1972.98,"discounted_cash":986.49,"setting":"both","billing_class":"facility"}]},{"description":"PRQ IMPLTJ NSTIM ELE","code_information":[{"code":"13135","type":"CDM"},{"code":"983","type":"RC"},{"code":"MANUL","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":15650.55,"discounted_cash":7825.27,"setting":"both","billing_class":"facility"}]},{"description":"ANLYZE NEUROSTM GEN","code_information":[{"code":"13136","type":"CDM"},{"code":"360","type":"RC"},{"code":"95971","type":"CPT"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":382.21,"discounted_cash":191.1,"setting":"both","billing_class":"facility"}]},{"description":"ANLYZE NEUROSTM GEN","code_information":[{"code":"13137","type":"CDM"},{"code":"360","type":"RC"},{"code":"95971","type":"CPT"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":382.21,"discounted_cash":191.1,"setting":"both","billing_class":"facility"}]},{"description":"DRAN INJ JNT BURSA L","code_information":[{"code":"13138","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":904.55,"discounted_cash":452.27,"setting":"both","billing_class":"facility"}]},{"description":"DRAN INJ JNT BURSA R","code_information":[{"code":"13139","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":904.55,"discounted_cash":452.27,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN INJ BURSA BIL","code_information":[{"code":"13140","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1809.05,"discounted_cash":904.52,"setting":"both","billing_class":"facility"}]},{"description":"INJ STEROID CER IMG","code_information":[{"code":"13141","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1831.26,"discounted_cash":915.63,"setting":"both","billing_class":"facility"}]},{"description":"INJ STEROID LUMB IMG","code_information":[{"code":"13142","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1831.26,"discounted_cash":915.63,"setting":"both","billing_class":"facility"}]},{"description":"OCCIPITAL NERVE BLOC","code_information":[{"code":"13143","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":904.55,"discounted_cash":452.27,"setting":"both","billing_class":"facility"}]},{"description":"INJ AXILLARY BLOCK","code_information":[{"code":"13144","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2339.91,"discounted_cash":1169.95,"setting":"both","billing_class":"facility"}]},{"description":"INJ INTERCOSTAL LT","code_information":[{"code":"13145","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1831.26,"discounted_cash":915.63,"setting":"both","billing_class":"facility"}]},{"description":"INJ INTERCOSTAL SG R","code_information":[{"code":"13146","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1831.26,"discounted_cash":915.63,"setting":"both","billing_class":"facility"}]},{"description":"INJ INTERCOSTAL SG B","code_information":[{"code":"13147","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":3610.74,"discounted_cash":1805.37,"setting":"both","billing_class":"facility"}]},{"description":"INJ INTERCOSTAL MULT","code_information":[{"code":"13148","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2339.91,"discounted_cash":1169.95,"setting":"both","billing_class":"facility"}]},{"description":"INJ INTERCOSTAL MULT","code_information":[{"code":"13149","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2339.91,"discounted_cash":1169.95,"setting":"both","billing_class":"facility"}]},{"description":"INJ INTERCOSTAL MULT","code_information":[{"code":"13150","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":4679.88,"discounted_cash":2339.94,"setting":"both","billing_class":"facility"}]},{"description":"INJ PERIPHERAL NERVE","code_information":[{"code":"13151","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1831.26,"discounted_cash":915.63,"setting":"both","billing_class":"facility"}]},{"description":"NERV BLK/CERV SGL LT","code_information":[{"code":"13152","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2339.91,"discounted_cash":1169.95,"setting":"both","billing_class":"facility"}]},{"description":"NERV BLK/CERV SGL RT","code_information":[{"code":"13153","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2339.91,"discounted_cash":1169.95,"setting":"both","billing_class":"facility"}]},{"description":"NERV BK/CERV SGL BIL","code_information":[{"code":"13154","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":4747.05,"discounted_cash":2373.53,"setting":"both","billing_class":"facility"}]},{"description":"NRV BK CRV/THR AD LT","code_information":[{"code":"13155","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":913.02,"discounted_cash":456.51,"setting":"both","billing_class":"facility"}]},{"description":"NRV BK CRV/THR AD RT","code_information":[{"code":"13156","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":913.02,"discounted_cash":456.51,"setting":"both","billing_class":"facility"}]},{"description":"NRV BLCK CRV/THR ADD","code_information":[{"code":"13157","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1826.09,"discounted_cash":913.04,"setting":"both","billing_class":"facility"}]},{"description":"INJ ANS EPI LM/SC LT","code_information":[{"code":"13158","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2373.5,"discounted_cash":1186.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ ANS EPI LM/SC RT","code_information":[{"code":"13159","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2373.5,"discounted_cash":1186.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ ANS EPI LUM/SAC","code_information":[{"code":"13160","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2373.5,"discounted_cash":1186.75,"setting":"both","billing_class":"facility"}]},{"description":"NRV BLCK LUM ADDL LT","code_information":[{"code":"13161","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":913.02,"discounted_cash":456.51,"setting":"both","billing_class":"facility"}]},{"description":"NRV BLCK LUM ADDL RT","code_information":[{"code":"13162","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":926.12,"discounted_cash":463.06,"setting":"both","billing_class":"facility"}]},{"description":"NRV BLCK LUM ADDL BI","code_information":[{"code":"13163","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1826.09,"discounted_cash":913.04,"setting":"both","billing_class":"facility"}]},{"description":"INJ CERV/THOR SGL LT","code_information":[{"code":"13164","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2373.5,"discounted_cash":1186.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ CERV/THOR SGL RT","code_information":[{"code":"13165","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2339.91,"discounted_cash":1169.95,"setting":"both","billing_class":"facility"}]},{"description":"INJ CERV/THOR SGL BI","code_information":[{"code":"13166","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":4747.05,"discounted_cash":2373.53,"setting":"both","billing_class":"facility"}]},{"description":"INJ CERV/THOR 2ND LT","code_information":[{"code":"13167","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":632.24,"discounted_cash":316.12,"setting":"both","billing_class":"facility"}]},{"description":"INJ CERV/THOR 2ND RT","code_information":[{"code":"13168","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":623.29,"discounted_cash":311.64,"setting":"both","billing_class":"facility"}]},{"description":"INJ CERV/THOR 2ND BI","code_information":[{"code":"13169","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.47,"discounted_cash":632.24,"setting":"both","billing_class":"facility"}]},{"description":"INJ CERV/THOR 3RD LT","code_information":[{"code":"13170","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":623.29,"discounted_cash":311.64,"setting":"both","billing_class":"facility"}]},{"description":"INJ CERV/THOR 3RD RT","code_information":[{"code":"13171","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":623.29,"discounted_cash":311.64,"setting":"both","billing_class":"facility"}]},{"description":"INJ CERV/THOR 3RD BI","code_information":[{"code":"13172","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1246.58,"discounted_cash":623.29,"setting":"both","billing_class":"facility"}]},{"description":"INJ LUM\\\\SAC SGL LT","code_information":[{"code":"13173","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2373.5,"discounted_cash":1186.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ LUM\\\\SAC SGL RT","code_information":[{"code":"13174","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2373.5,"discounted_cash":1186.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ LUM\\\\SAC SGL BIL","code_information":[{"code":"13175","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":4747.05,"discounted_cash":2373.53,"setting":"both","billing_class":"facility"}]},{"description":"INJ LUM\\\\SAC 2ND LT","code_information":[{"code":"13176","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":623.29,"discounted_cash":311.64,"setting":"both","billing_class":"facility"}]},{"description":"INJ LUM\\\\SAC 2ND RT","code_information":[{"code":"13177","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":632.24,"discounted_cash":316.12,"setting":"both","billing_class":"facility"}]},{"description":"INJ LUM\\\\SAC 2ND BIL","code_information":[{"code":"13178","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.47,"discounted_cash":632.24,"setting":"both","billing_class":"facility"}]},{"description":"INJ LUM\\\\SAC 3RD LT","code_information":[{"code":"13179","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":623.29,"discounted_cash":311.64,"setting":"both","billing_class":"facility"}]},{"description":"INJ LUM\\\\SAC 3RD RT","code_information":[{"code":"13180","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":623.29,"discounted_cash":311.64,"setting":"both","billing_class":"facility"}]},{"description":"INJ LUM\\\\SAC 3RD BIL","code_information":[{"code":"13181","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1246.58,"discounted_cash":623.29,"setting":"both","billing_class":"facility"}]},{"description":"INJ ANES STELLAT GNG","code_information":[{"code":"13182","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2339.91,"discounted_cash":1169.95,"setting":"both","billing_class":"facility"}]},{"description":"INJ ANS LMB SYMPT LT","code_information":[{"code":"13183","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2339.91,"discounted_cash":1169.95,"setting":"both","billing_class":"facility"}]},{"description":"INJ ANES LMB SYMP RT","code_information":[{"code":"13184","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2339.91,"discounted_cash":1169.95,"setting":"both","billing_class":"facility"}]},{"description":"INJ ANS LUMB SYMP BL","code_information":[{"code":"13185","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":4679.88,"discounted_cash":2339.94,"setting":"both","billing_class":"facility"}]},{"description":"DSTR CERV FCT JNT RT","code_information":[{"code":"13186","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":4556.57,"discounted_cash":2278.28,"setting":"both","billing_class":"facility"}]},{"description":"DESTR CRV FCT JNT BI","code_information":[{"code":"13187","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":8984.18,"discounted_cash":4492.09,"setting":"both","billing_class":"facility"}]},{"description":"DST C/TH FCT JNT  LT","code_information":[{"code":"13188","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":632.24,"discounted_cash":316.12,"setting":"both","billing_class":"facility"}]},{"description":"DEST C/TH FCT JNT AD","code_information":[{"code":"13189","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":632.24,"discounted_cash":316.12,"setting":"both","billing_class":"facility"}]},{"description":"DST C/TH FCT JNT ADB","code_information":[{"code":"13190","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":623.29,"discounted_cash":311.64,"setting":"both","billing_class":"facility"}]},{"description":"DSTR LUMB FCT INJ RT","code_information":[{"code":"13191","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":4556.57,"discounted_cash":2278.28,"setting":"both","billing_class":"facility"}]},{"description":"DST LMB FACET INJ BL","code_information":[{"code":"13192","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":8984.18,"discounted_cash":4492.09,"setting":"both","billing_class":"facility"}]},{"description":"DEST LS FCT JNT ADD","code_information":[{"code":"13193","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1632.61,"discounted_cash":816.3,"setting":"both","billing_class":"facility"}]},{"description":"DST L/S FCT JT ADD B","code_information":[{"code":"13194","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":3265.22,"discounted_cash":1632.61,"setting":"both","billing_class":"facility"}]},{"description":"DESTRUCT OTH PERIPHR","code_information":[{"code":"13195","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2373.5,"discounted_cash":1186.75,"setting":"both","billing_class":"facility"}]},{"description":"DRN/INJ MJ JNT/BUR U","code_information":[{"code":"13196","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.75,"discounted_cash":445.88,"setting":"both","billing_class":"facility"}]},{"description":"INJ ILIOINGUOL NERV","code_information":[{"code":"13197","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1831.26,"discounted_cash":915.63,"setting":"both","billing_class":"facility"}]},{"description":"INJ SACROILIAC JNT L","code_information":[{"code":"13198","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2904.29,"discounted_cash":1452.14,"setting":"both","billing_class":"facility"}]},{"description":"INJ SACROILIAC JNT R","code_information":[{"code":"13199","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2904.29,"discounted_cash":1452.14,"setting":"both","billing_class":"facility"}]},{"description":"INJ SACROILIAC JNT B","code_information":[{"code":"13200","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":5808.64,"discounted_cash":2904.32,"setting":"both","billing_class":"facility"}]},{"description":"INJ TRIGGER PNT 3","code_information":[{"code":"13201","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":904.55,"discounted_cash":452.27,"setting":"both","billing_class":"facility"}]},{"description":"INJ NERVE SI JT","code_information":[{"code":"13202","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1805.34,"discounted_cash":902.67,"setting":"both","billing_class":"facility"}]},{"description":"INJ GENICULAR NERVE","code_information":[{"code":"13203","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1831.26,"discounted_cash":915.63,"setting":"both","billing_class":"facility"}]},{"description":"DEST NEUROL GEN NERV","code_information":[{"code":"13204","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":4556.57,"discounted_cash":2278.28,"setting":"both","billing_class":"facility"}]},{"description":"RF ABLAT NERVE SI JT","code_information":[{"code":"13205","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":4492.09,"discounted_cash":2246.05,"setting":"both","billing_class":"facility"}]},{"description":"BLOCK FEMORAL NERVE","code_information":[{"code":"13206","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1805.34,"discounted_cash":902.67,"setting":"both","billing_class":"facility"}]},{"description":"PAIN PROCEDURE","code_information":[{"code":"13207","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2076.94,"discounted_cash":1038.47,"setting":"both","billing_class":"facility"}]},{"description":"OP CONSULTS","code_information":[{"code":"13208","type":"CDM"},{"code":"963","type":"RC"},{"code":"99243","type":"CPT"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1999.45,"discounted_cash":999.73,"setting":"both","billing_class":"facility"}]},{"description":"LABOR EPIDURAL","code_information":[{"code":"13210","type":"CDM"},{"code":"964","type":"RC"},{"code":"MANUL","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":6211.74,"discounted_cash":3105.87,"setting":"both","billing_class":"facility"}]},{"description":"PAIN MGT URINE DRUG","code_information":[{"code":"13211","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0483","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":693.2,"discounted_cash":346.6,"setting":"both","billing_class":"facility"}]},{"description":"NERVE BLCK SUPRASCAP","code_information":[{"code":"13212","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.71,"discounted_cash":960.36,"setting":"both","billing_class":"facility"}]},{"description":"NERVE BLCK CELIAC PL","code_information":[{"code":"13213","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":7988.5,"discounted_cash":3994.25,"setting":"both","billing_class":"facility"}]},{"description":"UNLISTED PX NERVOUS","code_information":[{"code":"13214","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":486.5,"setting":"both","billing_class":"facility"}]},{"description":"ANES 1ST 15MIN","code_information":[{"code":"13267","type":"CDM"},{"code":"370","type":"RC"},{"code":"64530","type":"CPT"},{"code":"790","type":"LOCAL"}],"standard_charges":[{"gross_charge":814.77,"discounted_cash":407.38,"setting":"both","billing_class":"facility"}]},{"description":"ANES EA ADD 15MIN","code_information":[{"code":"13268","type":"CDM"},{"code":"370","type":"RC"},{"code":"64530","type":"CPT"},{"code":"790","type":"LOCAL"}],"standard_charges":[{"gross_charge":407.41,"discounted_cash":203.71,"setting":"both","billing_class":"facility"}]},{"description":"ANES EPIDURAL","code_information":[{"code":"13269","type":"CDM"},{"code":"370","type":"RC"},{"code":"64530","type":"CPT"},{"code":"790","type":"LOCAL"}],"standard_charges":[{"gross_charge":671.31,"discounted_cash":335.65,"setting":"both","billing_class":"facility"}]},{"description":"ANES LOCAL","code_information":[{"code":"13270","type":"CDM"},{"code":"370","type":"RC"},{"code":"64530","type":"CPT"},{"code":"790","type":"LOCAL"}],"standard_charges":[{"gross_charge":538.8,"discounted_cash":269.4,"setting":"both","billing_class":"facility"}]},{"description":"ANES SPINAL","code_information":[{"code":"13271","type":"CDM"},{"code":"370","type":"RC"},{"code":"64530","type":"CPT"},{"code":"790","type":"LOCAL"}],"standard_charges":[{"gross_charge":882.29,"discounted_cash":441.14,"setting":"both","billing_class":"facility"}]},{"description":"ANES CONS SED","code_information":[{"code":"13272","type":"CDM"},{"code":"370","type":"RC"},{"code":"64530","type":"CPT"},{"code":"790","type":"LOCAL"}],"standard_charges":[{"gross_charge":270.97,"discounted_cash":135.49,"setting":"both","billing_class":"facility"}]},{"description":"ANES MAC 1ST 15 MIN","code_information":[{"code":"13273","type":"CDM"},{"code":"370","type":"RC"},{"code":"64530","type":"CPT"},{"code":"790","type":"LOCAL"}],"standard_charges":[{"gross_charge":750.06,"discounted_cash":375.03,"setting":"both","billing_class":"facility"}]},{"description":"ANES MAC ADD 15 MIN","code_information":[{"code":"13274","type":"CDM"},{"code":"370","type":"RC"},{"code":"64530","type":"CPT"},{"code":"790","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.73,"discounted_cash":3.37,"setting":"both","billing_class":"facility"}]},{"description":"ANES REGIONAL","code_information":[{"code":"13275","type":"CDM"},{"code":"370","type":"RC"},{"code":"64530","type":"CPT"},{"code":"790","type":"LOCAL"}],"standard_charges":[{"gross_charge":837.72,"discounted_cash":418.86,"setting":"both","billing_class":"facility"}]},{"description":"PET BRAIN METBLC INI","code_information":[{"code":"13337","type":"CDM"},{"code":"404","type":"RC"},{"code":"78608","type":"CPT"},{"code":"677","type":"LOCAL"}],"standard_charges":[{"gross_charge":3560.37,"discounted_cash":1780.18,"setting":"both","billing_class":"facility"}]},{"description":"PET BRAIN METBLC SUB","code_information":[{"code":"13338","type":"CDM"},{"code":"404","type":"RC"},{"code":"78608","type":"CPT"},{"code":"677","type":"LOCAL"}],"standard_charges":[{"gross_charge":3560.37,"discounted_cash":1780.18,"setting":"both","billing_class":"facility"}]},{"description":"FLUCICLOVINE F18 1MC","code_information":[{"code":"13339","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9588","type":"HCPCS"},{"code":"677","type":"LOCAL"}],"standard_charges":[{"gross_charge":1129.07,"discounted_cash":564.53,"setting":"both","billing_class":"facility"}]},{"description":"PT W/CT SKL-THI PI","code_information":[{"code":"13348","type":"CDM"},{"code":"404","type":"RC"},{"code":"78815","type":"CPT"},{"code":"677","type":"LOCAL"}],"standard_charges":[{"gross_charge":7684.56,"discounted_cash":3842.28,"setting":"both","billing_class":"facility"}]},{"description":"PT W/CT SKL-THI PS","code_information":[{"code":"13349","type":"CDM"},{"code":"404","type":"RC"},{"code":"78815","type":"CPT"},{"code":"677","type":"LOCAL"}],"standard_charges":[{"gross_charge":7684.56,"discounted_cash":3842.28,"setting":"both","billing_class":"facility"}]},{"description":"PT W/CT FULL BODY PI","code_information":[{"code":"13350","type":"CDM"},{"code":"404","type":"RC"},{"code":"78816","type":"CPT"},{"code":"677","type":"LOCAL"}],"standard_charges":[{"gross_charge":9793.95,"discounted_cash":4896.98,"setting":"both","billing_class":"facility"}]},{"description":"PT W/CT FULL BODY PS","code_information":[{"code":"13351","type":"CDM"},{"code":"404","type":"RC"},{"code":"78816","type":"CPT"},{"code":"677","type":"LOCAL"}],"standard_charges":[{"gross_charge":9793.95,"discounted_cash":4896.98,"setting":"both","billing_class":"facility"}]},{"description":"F-18 FDG UP TO 45MCI","code_information":[{"code":"13352","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9552","type":"HCPCS"},{"code":"677","type":"LOCAL"}],"standard_charges":[{"gross_charge":1258.65,"discounted_cash":629.33,"setting":"both","billing_class":"facility"}]},{"description":"TAP BLOCK BI INJECT","code_information":[{"code":"13353","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1645.88,"discounted_cash":822.94,"setting":"both","billing_class":"facility"}]},{"description":"CYSTOSTOMY TUBE CHAN","code_information":[{"code":"13354","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":854.55,"discounted_cash":427.27,"setting":"both","billing_class":"facility"}]},{"description":"THP SPI PNX CSF FLCT","code_information":[{"code":"13355","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1988.11,"discounted_cash":994.05,"setting":"both","billing_class":"facility"}]},{"description":"SP PERM NEUROSTIM","code_information":[{"code":"13356","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":31513.39,"discounted_cash":15756.69,"setting":"both","billing_class":"facility"}]},{"description":"SP FNA W/O IMAGING","code_information":[{"code":"13357","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":516.75,"discounted_cash":258.38,"setting":"both","billing_class":"facility"}]},{"description":"SP FNA W/GUIDANCE","code_information":[{"code":"13358","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1426.16,"discounted_cash":713.08,"setting":"both","billing_class":"facility"}]},{"description":"SP DRN PRC SOFT TISS","code_information":[{"code":"13359","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.64,"discounted_cash":853.32,"setting":"both","billing_class":"facility"}]},{"description":"SP I&D HEMA/SEROMA","code_information":[{"code":"13361","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3326.03,"discounted_cash":1663.02,"setting":"both","billing_class":"facility"}]},{"description":"SP PUNCTURE ASP","code_information":[{"code":"13362","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.96,"discounted_cash":420.48,"setting":"both","billing_class":"facility"}]},{"description":"SP I&D SFT TISS ABS","code_information":[{"code":"13363","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3556.5,"discounted_cash":1778.25,"setting":"both","billing_class":"facility"}]},{"description":"SP BX MUSCLE PERC","code_information":[{"code":"13365","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2540.71,"discounted_cash":1270.36,"setting":"both","billing_class":"facility"}]},{"description":"SP BX BN SUPERFICIAL","code_information":[{"code":"13366","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2540.71,"discounted_cash":1270.36,"setting":"both","billing_class":"facility"}]},{"description":"SP BX BN DEEP","code_information":[{"code":"13367","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2411.55,"discounted_cash":1205.78,"setting":"both","billing_class":"facility"}]},{"description":"SP SINOGRAM DIAG","code_information":[{"code":"13368","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":756.11,"discounted_cash":378.06,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ TR PNT 1-2 M","code_information":[{"code":"13369","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":601.61,"discounted_cash":300.81,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ SCLERO FISTU","code_information":[{"code":"13370","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2960.9,"discounted_cash":1480.45,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ TR PNT =>3M","code_information":[{"code":"13371","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":652.24,"discounted_cash":326.12,"setting":"both","billing_class":"facility"}]},{"description":"SP ARTHROCENT MINOR","code_information":[{"code":"13372","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.29,"discounted_cash":221.65,"setting":"both","billing_class":"facility"}]},{"description":"SP ARTHROCENT MAJOR","code_information":[{"code":"13373","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":601.61,"discounted_cash":300.81,"setting":"both","billing_class":"facility"}]},{"description":"SP BX NECK/THORAX","code_information":[{"code":"13375","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2221.57,"discounted_cash":1110.79,"setting":"both","billing_class":"facility"}]},{"description":"SP VERTEBRO CT","code_information":[{"code":"13376","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6682.41,"discounted_cash":3341.2,"setting":"both","billing_class":"facility"}]},{"description":"SP VERTEBRO LS","code_information":[{"code":"13377","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6682.41,"discounted_cash":3341.2,"setting":"both","billing_class":"facility"}]},{"description":"SP VERTEBRO ADD","code_information":[{"code":"13378","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6682.41,"discounted_cash":3341.2,"setting":"both","billing_class":"facility"}]},{"description":"SP KYPHO THORA","code_information":[{"code":"13382","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":14556.69,"discounted_cash":7278.35,"setting":"both","billing_class":"facility"}]},{"description":"SP KYPHO LUMB","code_information":[{"code":"13383","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":14556.69,"discounted_cash":7278.35,"setting":"both","billing_class":"facility"}]},{"description":"SP KYPHO ADD LVL","code_information":[{"code":"13387","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":14556.69,"discounted_cash":7278.35,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ HIP X-RAY","code_information":[{"code":"13390","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":556.04,"discounted_cash":278.02,"setting":"both","billing_class":"facility"}]},{"description":"SP PERC BX PLEURA","code_information":[{"code":"13393","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2348.22,"discounted_cash":1174.11,"setting":"both","billing_class":"facility"}]},{"description":"SP PERC BX LUNG","code_information":[{"code":"13394","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2348.22,"discounted_cash":1174.11,"setting":"both","billing_class":"facility"}]},{"description":"SP THORACENT W/O IMG","code_information":[{"code":"13395","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2165.87,"discounted_cash":1082.93,"setting":"both","billing_class":"facility"}]},{"description":"SP THORACENT W/IMG","code_information":[{"code":"13396","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":865.05,"discounted_cash":432.52,"setting":"both","billing_class":"facility"}]},{"description":"SP INS LUNG CATH","code_information":[{"code":"13397","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6039.06,"discounted_cash":3019.53,"setting":"both","billing_class":"facility"}]},{"description":"SP THORACOSTOMY","code_information":[{"code":"13398","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2165.87,"discounted_cash":1082.93,"setting":"both","billing_class":"facility"}]},{"description":"SP REM LUNG CATH","code_information":[{"code":"13399","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1123.43,"discounted_cash":561.72,"setting":"both","billing_class":"facility"}]},{"description":"SP PERQ PNEUMO W IMG","code_information":[{"code":"13401","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1709.83,"discounted_cash":854.91,"setting":"both","billing_class":"facility"}]},{"description":"SP CHEST TUBE LYSIS","code_information":[{"code":"13402","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1141.19,"discounted_cash":570.6,"setting":"both","billing_class":"facility"}]},{"description":"SP VASCULAR INJECT","code_information":[{"code":"13403","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.91,"discounted_cash":168.46,"setting":"both","billing_class":"facility"}]},{"description":"SP INS TEMP PM","code_information":[{"code":"13404","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":11578.03,"discounted_cash":5789.02,"setting":"both","billing_class":"facility"}]},{"description":"SP CENTRAL DIA PTA","code_information":[{"code":"13405","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":8368.31,"discounted_cash":4184.15,"setting":"both","billing_class":"facility"}]},{"description":"SP TBA BRACHIOCEPHAL","code_information":[{"code":"13407","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":10162.99,"discounted_cash":5081.49,"setting":"both","billing_class":"facility"}]},{"description":"SP TBA VENOUS","code_information":[{"code":"13408","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6266.97,"discounted_cash":3133.49,"setting":"both","billing_class":"facility"}]},{"description":"SP VENOGRAPHY","code_information":[{"code":"13409","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":514.24,"discounted_cash":257.12,"setting":"both","billing_class":"facility"}]},{"description":"SP PLC CATH SUP/IVC","code_information":[{"code":"13410","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1265.29,"discounted_cash":632.64,"setting":"both","billing_class":"facility"}]},{"description":"SP PLC CATH VENOUS","code_information":[{"code":"13411","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2108.86,"discounted_cash":1054.43,"setting":"both","billing_class":"facility"}]},{"description":"SP PLC CATH 2ND ORD","code_information":[{"code":"13412","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":889.09,"discounted_cash":444.55,"setting":"both","billing_class":"facility"}]},{"description":"SP INT NDL/CATH ARTE","code_information":[{"code":"13414","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1932.78,"discounted_cash":966.39,"setting":"both","billing_class":"facility"}]},{"description":"SP AV SHUNTOGRAM","code_information":[{"code":"13417","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2637.01,"discounted_cash":1318.51,"setting":"both","billing_class":"facility"}]},{"description":"SP AV SHUNT W TBA ST","code_information":[{"code":"13418","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":30069.77,"discounted_cash":15034.89,"setting":"both","billing_class":"facility"}]},{"description":"SP INT CATH AORTA","code_information":[{"code":"13419","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1674.4,"discounted_cash":837.2,"setting":"both","billing_class":"facility"}]},{"description":"SP 1ST ORD THOR/BRAC","code_information":[{"code":"13420","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.45,"discounted_cash":704.23,"setting":"both","billing_class":"facility"}]},{"description":"SP 2ND ORD THOR/BRAC","code_information":[{"code":"13421","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1837.79,"discounted_cash":918.89,"setting":"both","billing_class":"facility"}]},{"description":"SP 3RD ORD THOR/BRAC","code_information":[{"code":"13422","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1462.9,"discounted_cash":731.45,"setting":"both","billing_class":"facility"}]},{"description":"SP 2/3 ORD THOR/BRAC","code_information":[{"code":"13423","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":724.45,"discounted_cash":362.23,"setting":"both","billing_class":"facility"}]},{"description":"SP 1ST ORD ABD/PEL/L","code_information":[{"code":"13424","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1674.4,"discounted_cash":837.2,"setting":"both","billing_class":"facility"}]},{"description":"SP 2ND ORD ABD/PEL/L","code_information":[{"code":"13425","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2426.75,"discounted_cash":1213.38,"setting":"both","billing_class":"facility"}]},{"description":"SP 3RD ORD ABD/PEL/L","code_information":[{"code":"13426","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2639.57,"discounted_cash":1319.79,"setting":"both","billing_class":"facility"}]},{"description":"SP 2/3 ORD ABD/PEL/L","code_information":[{"code":"13427","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1104.41,"discounted_cash":552.21,"setting":"both","billing_class":"facility"}]},{"description":"SP SCLEROS INJ VEIN","code_information":[{"code":"13429","type":"CDM"},{"code":"361","type":"RC"},{"code":"36468","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.75,"discounted_cash":290.88,"setting":"both","billing_class":"facility"}]},{"description":"SP RENAL ANGIO UNI","code_information":[{"code":"13430","type":"CDM"},{"code":"361","type":"RC"},{"code":"36251","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3581.95,"discounted_cash":1790.97,"setting":"both","billing_class":"facility"}]},{"description":"SP RENAL ANGIO BIL","code_information":[{"code":"13431","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5284.15,"discounted_cash":2642.07,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ SCLERO SGL VN","code_information":[{"code":"13433","type":"CDM"},{"code":"361","type":"RC"},{"code":"36470","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1020.55,"discounted_cash":510.27,"setting":"both","billing_class":"facility"}]},{"description":"SP ENDO LASR 1ST VN","code_information":[{"code":"13434","type":"CDM"},{"code":"361","type":"RC"},{"code":"36478","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3989.71,"discounted_cash":1994.86,"setting":"both","billing_class":"facility"}]},{"description":"SP ENDO LASR ADD VN","code_information":[{"code":"13435","type":"CDM"},{"code":"361","type":"RC"},{"code":"36479","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4498.88,"discounted_cash":2249.44,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ SCLERO MLT VN","code_information":[{"code":"13436","type":"CDM"},{"code":"361","type":"RC"},{"code":"36471","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":949.96,"discounted_cash":474.98,"setting":"both","billing_class":"facility"}]},{"description":"SP INS NONTUN CVD","code_information":[{"code":"13437","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3246.19,"discounted_cash":1623.1,"setting":"both","billing_class":"facility"}]},{"description":"SP INS TUN CVD W/O","code_information":[{"code":"13438","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6179.61,"discounted_cash":3089.8,"setting":"both","billing_class":"facility"}]},{"description":"SP INS TUN CVD W/P","code_information":[{"code":"13439","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":8016.14,"discounted_cash":4008.07,"setting":"both","billing_class":"facility"}]},{"description":"SP INS TUN CVD 2 ACC","code_information":[{"code":"13440","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4920.59,"discounted_cash":2460.3,"setting":"both","billing_class":"facility"}]},{"description":"SP PICC PLC >5YR W/P","code_information":[{"code":"13442","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5542.52,"discounted_cash":2771.26,"setting":"both","billing_class":"facility"}]},{"description":"INS PICC RS&I 5 YR+","code_information":[{"code":"13443","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4148.65,"discounted_cash":2074.32,"setting":"both","billing_class":"facility"}]},{"description":"SP RPL CMP CVC W/O","code_information":[{"code":"13447","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5275.26,"discounted_cash":2637.63,"setting":"both","billing_class":"facility"}]},{"description":"SP RPL TUN CVC W/P","code_information":[{"code":"13448","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5413.31,"discounted_cash":2706.66,"setting":"both","billing_class":"facility"}]},{"description":"SP RPL CMP CVC W/P","code_information":[{"code":"13449","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":11182.55,"discounted_cash":5591.27,"setting":"both","billing_class":"facility"}]},{"description":"SP RMV TUN CVC W/O","code_information":[{"code":"13450","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1779.53,"discounted_cash":889.76,"setting":"both","billing_class":"facility"}]},{"description":"SP RMV TUN CVC","code_information":[{"code":"13451","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3628.71,"discounted_cash":1814.36,"setting":"both","billing_class":"facility"}]},{"description":"SP DECLOT VAD","code_information":[{"code":"13452","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":569.94,"discounted_cash":284.97,"setting":"both","billing_class":"facility"}]},{"description":"SP MECH RMV PERICATH","code_information":[{"code":"13453","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6728.34,"discounted_cash":3364.17,"setting":"both","billing_class":"facility"}]},{"description":"SP REPOSITION CVC","code_information":[{"code":"13455","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2683.87,"discounted_cash":1341.93,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ CV DEV EVAL","code_information":[{"code":"13456","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":951.21,"discounted_cash":475.61,"setting":"both","billing_class":"facility"}]},{"description":"SP INF TRANSCATH TX","code_information":[{"code":"13458","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2595.21,"discounted_cash":1297.61,"setting":"both","billing_class":"facility"}]},{"description":"SP INF TRNSCTH ADD L","code_information":[{"code":"13459","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2595.21,"discounted_cash":1297.61,"setting":"both","billing_class":"facility"}]},{"description":"SP ARTERIAL TBA ADD","code_information":[{"code":"13460","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6875.42,"discounted_cash":3437.71,"setting":"both","billing_class":"facility"}]},{"description":"SP REV TIPS","code_information":[{"code":"13462","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":19511.56,"discounted_cash":9755.78,"setting":"both","billing_class":"facility"}]},{"description":"SP ART THRMBCTMY 1ST","code_information":[{"code":"13463","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":11182.55,"discounted_cash":5591.27,"setting":"both","billing_class":"facility"}]},{"description":"SP ART THRMBCTMY ADD","code_information":[{"code":"13464","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3870.68,"discounted_cash":1935.34,"setting":"both","billing_class":"facility"}]},{"description":"SP ARTERIAL TBA INT","code_information":[{"code":"13465","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":13750.21,"discounted_cash":6875.1,"setting":"both","billing_class":"facility"}]},{"description":"SP VENOUS TROMBECT","code_information":[{"code":"13466","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":11182.55,"discounted_cash":5591.27,"setting":"both","billing_class":"facility"}]},{"description":"SP INS IVC W/IMAGING","code_information":[{"code":"13468","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":8896.4,"discounted_cash":4448.2,"setting":"both","billing_class":"facility"}]},{"description":"SP TRNSCTH TXINF ART","code_information":[{"code":"13469","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":11182.55,"discounted_cash":5591.27,"setting":"both","billing_class":"facility"}]},{"description":"THROMBLYTIC ART/VEN","code_information":[{"code":"13476","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4410.21,"discounted_cash":2205.11,"setting":"both","billing_class":"facility"}]},{"description":"THRMBLYTC TX W/RMV","code_information":[{"code":"13477","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4410.21,"discounted_cash":2205.11,"setting":"both","billing_class":"facility"}]},{"description":"THROMBLYTC VENOUS TX","code_information":[{"code":"13479","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3166.45,"discounted_cash":1583.22,"setting":"both","billing_class":"facility"}]},{"description":"SP RMV IVC FILTER","code_information":[{"code":"13480","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4715.41,"discounted_cash":2357.7,"setting":"both","billing_class":"facility"}]},{"description":"SP REV ILIAC W/TLA","code_information":[{"code":"13481","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":18901.12,"discounted_cash":9450.56,"setting":"both","billing_class":"facility"}]},{"description":"SP REV ILIAC STENT","code_information":[{"code":"13482","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":30653.66,"discounted_cash":15326.83,"setting":"both","billing_class":"facility"}]},{"description":"SP REV ILIAC TLA AD","code_information":[{"code":"13483","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":15605.46,"discounted_cash":7802.73,"setting":"both","billing_class":"facility"}]},{"description":"SP REV ILIAC STNT AD","code_information":[{"code":"13484","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":25834.33,"discounted_cash":12917.17,"setting":"both","billing_class":"facility"}]},{"description":"SP REV FEM/POP TLA","code_information":[{"code":"13485","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":18901.12,"discounted_cash":9450.56,"setting":"both","billing_class":"facility"}]},{"description":"SP REV FEM/POP ATHR","code_information":[{"code":"13486","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":36553.73,"discounted_cash":18276.87,"setting":"both","billing_class":"facility"}]},{"description":"SP REV FEM/POP STNT","code_information":[{"code":"13487","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":30653.66,"discounted_cash":15326.83,"setting":"both","billing_class":"facility"}]},{"description":"SP REV FEM/POP ST/AT","code_information":[{"code":"13488","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":44601.17,"discounted_cash":22300.58,"setting":"both","billing_class":"facility"}]},{"description":"SP REV TIB/PER W/TLA","code_information":[{"code":"13489","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":18901.12,"discounted_cash":9450.56,"setting":"both","billing_class":"facility"}]},{"description":"SP REV TIB/PER ATHER","code_information":[{"code":"13490","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":32764.72,"discounted_cash":16382.36,"setting":"both","billing_class":"facility"}]},{"description":"SP REV TIB/PER TLA A","code_information":[{"code":"13493","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":15605.46,"discounted_cash":7802.73,"setting":"both","billing_class":"facility"}]},{"description":"SP REV TIB/PER ATH A","code_information":[{"code":"13494","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":28871.57,"discounted_cash":14435.78,"setting":"both","billing_class":"facility"}]},{"description":"SP REV TIB/PER STN A","code_information":[{"code":"13495","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":16382.36,"discounted_cash":8191.18,"setting":"both","billing_class":"facility"}]},{"description":"SP REV TIB/PER ST/AT","code_information":[{"code":"13496","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":39722.33,"discounted_cash":19861.17,"setting":"both","billing_class":"facility"}]},{"description":"SP PLC IV ST 1ST ART","code_information":[{"code":"13497","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":25309.95,"discounted_cash":12654.98,"setting":"both","billing_class":"facility"}]},{"description":"SP PLC IV ST 1ST VN","code_information":[{"code":"13499","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":25309.95,"discounted_cash":12654.98,"setting":"both","billing_class":"facility"}]},{"description":"SP EMBO/OCCL VEIN","code_information":[{"code":"13502","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":17697.86,"discounted_cash":8848.93,"setting":"both","billing_class":"facility"}]},{"description":"SP EMBO/OCCL ART","code_information":[{"code":"13503","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":17696.55,"discounted_cash":8848.27,"setting":"both","billing_class":"facility"}]},{"description":"SP BN MARROW BX","code_information":[{"code":"13506","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3457.75,"discounted_cash":1728.88,"setting":"both","billing_class":"facility"}]},{"description":"SP BX LYMPH NODE","code_information":[{"code":"13507","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2657.8,"discounted_cash":1328.9,"setting":"both","billing_class":"facility"}]},{"description":"SP LYMPHOCELE SCLERO","code_information":[{"code":"13508","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":949.96,"discounted_cash":474.98,"setting":"both","billing_class":"facility"}]},{"description":"SP REV ILIAC STNT BI","code_information":[{"code":"13509","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":23931.6,"discounted_cash":11965.8,"setting":"both","billing_class":"facility"}]},{"description":"SP NG TUBE PLC PERC","code_information":[{"code":"13511","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.29,"discounted_cash":221.65,"setting":"both","billing_class":"facility"}]},{"description":"SP CHANGE G-TUBE","code_information":[{"code":"13512","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":472.39,"discounted_cash":236.19,"setting":"both","billing_class":"facility"}]},{"description":"SP REPOS G-TUBE","code_information":[{"code":"13513","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1725.03,"discounted_cash":862.51,"setting":"both","billing_class":"facility"}]},{"description":"SP LIVER BX","code_information":[{"code":"13515","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2134.15,"discounted_cash":1067.08,"setting":"both","billing_class":"facility"}]},{"description":"SP CHOLECYSTO PERC","code_information":[{"code":"13518","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6039.06,"discounted_cash":3019.53,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ CHOLE PX ACCE","code_information":[{"code":"13520","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6039.06,"discounted_cash":3019.53,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ T-TUBE CHOLE","code_information":[{"code":"13521","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6039.06,"discounted_cash":3019.53,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ NEW CHOLANGRM","code_information":[{"code":"13522","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6039.06,"discounted_cash":3019.53,"setting":"both","billing_class":"facility"}]},{"description":"SP CHOLANGIO PTC","code_information":[{"code":"13523","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6039.06,"discounted_cash":3019.53,"setting":"both","billing_class":"facility"}]},{"description":"SP REM BILIARY DRAIN","code_information":[{"code":"13528","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1077.81,"discounted_cash":538.9,"setting":"both","billing_class":"facility"}]},{"description":"SP INTR BILIARY DRN","code_information":[{"code":"13529","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6021.29,"discounted_cash":3010.64,"setting":"both","billing_class":"facility"}]},{"description":"SP CHG BILIARY DRN","code_information":[{"code":"13530","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6021.29,"discounted_cash":3010.64,"setting":"both","billing_class":"facility"}]},{"description":"SP BILI ENDO W/BX","code_information":[{"code":"13531","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":8158.99,"discounted_cash":4079.49,"setting":"both","billing_class":"facility"}]},{"description":"SP CHOLANGIOPLASTY","code_information":[{"code":"13532","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6039.06,"discounted_cash":3019.53,"setting":"both","billing_class":"facility"}]},{"description":"SP NDL BX PANCREAS","code_information":[{"code":"13533","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2535.69,"discounted_cash":1267.85,"setting":"both","billing_class":"facility"}]},{"description":"SP PARACENTIS W/IMG","code_information":[{"code":"13540","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1486.93,"discounted_cash":743.47,"setting":"both","billing_class":"facility"}]},{"description":"SP PARACENT W/O IMG","code_information":[{"code":"13541","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1486.93,"discounted_cash":743.47,"setting":"both","billing_class":"facility"}]},{"description":"SP BX ABD MASS","code_information":[{"code":"13542","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1817.52,"discounted_cash":908.76,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ AIR CONTRAST","code_information":[{"code":"13543","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":939.82,"discounted_cash":469.91,"setting":"both","billing_class":"facility"}]},{"description":"SP DRN PRC VISCERAL","code_information":[{"code":"13544","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3525.2,"discounted_cash":1762.6,"setting":"both","billing_class":"facility"}]},{"description":"SP DRN PRC RTR/PERI","code_information":[{"code":"13545","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3525.2,"discounted_cash":1762.6,"setting":"both","billing_class":"facility"}]},{"description":"SP EXCH DRN CATH","code_information":[{"code":"13547","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2331.76,"discounted_cash":1165.88,"setting":"both","billing_class":"facility"}]},{"description":"SP ACESS DRN CATH","code_information":[{"code":"13548","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":447.05,"discounted_cash":223.53,"setting":"both","billing_class":"facility"}]},{"description":"SP DRN PRC R/P TV/TR","code_information":[{"code":"13549","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.86,"discounted_cash":949.93,"setting":"both","billing_class":"facility"}]},{"description":"SP PLC G TUBE","code_information":[{"code":"13550","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.86,"discounted_cash":949.93,"setting":"both","billing_class":"facility"}]},{"description":"SP PLC G-J TUBE PERC","code_information":[{"code":"13551","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2216.5,"discounted_cash":1108.25,"setting":"both","billing_class":"facility"}]},{"description":"FLUORO EX G/COLON TB","code_information":[{"code":"13552","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.45,"discounted_cash":423.23,"setting":"both","billing_class":"facility"}]},{"description":"SP G-TUBE EXCHANGE","code_information":[{"code":"13553","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2216.5,"discounted_cash":1108.25,"setting":"both","billing_class":"facility"}]},{"description":"SP FIBINOLYSIS ABD","code_information":[{"code":"13555","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4432.99,"discounted_cash":2216.49,"setting":"both","billing_class":"facility"}]},{"description":"SP RENAL BX","code_information":[{"code":"13557","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3457.75,"discounted_cash":1728.88,"setting":"both","billing_class":"facility"}]},{"description":"SP AV & MECH THROM","code_information":[{"code":"13558","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":15955.06,"discounted_cash":7977.53,"setting":"both","billing_class":"facility"}]},{"description":"SP AV STENT TBA MECH","code_information":[{"code":"13559","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":39880.65,"discounted_cash":19940.33,"setting":"both","billing_class":"facility"}]},{"description":"SP AV TBA DIALYSIS","code_information":[{"code":"13560","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":16737.77,"discounted_cash":8368.89,"setting":"both","billing_class":"facility"}]},{"description":"SP AV TBA/MECH THROM","code_information":[{"code":"13561","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":30069.77,"discounted_cash":15034.89,"setting":"both","billing_class":"facility"}]},{"description":"SP CHG URETERAL STNT","code_information":[{"code":"13562","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4687.87,"discounted_cash":2343.93,"setting":"both","billing_class":"facility"}]},{"description":"SP DIALYS CRCT EMBOL","code_information":[{"code":"13563","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6855.98,"discounted_cash":3427.99,"setting":"both","billing_class":"facility"}]},{"description":"SP RMV URETERAL STNT","code_information":[{"code":"13564","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4687.87,"discounted_cash":2343.93,"setting":"both","billing_class":"facility"}]},{"description":"SP CONVERT NEPH TUBE","code_information":[{"code":"13566","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1076.56,"discounted_cash":538.28,"setting":"both","billing_class":"facility"}]},{"description":"SP RMV RENAL TUBE FL","code_information":[{"code":"13567","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1127.24,"discounted_cash":563.62,"setting":"both","billing_class":"facility"}]},{"description":"SP DRN RENAL CYST","code_information":[{"code":"13568","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2314.05,"discounted_cash":1157.03,"setting":"both","billing_class":"facility"}]},{"description":"SP INT GUIDE KIDNEY","code_information":[{"code":"13572","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4432.99,"discounted_cash":2216.49,"setting":"both","billing_class":"facility"}]},{"description":"NEPHROSTMY CATH PLMT","code_information":[{"code":"13574","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2786.44,"discounted_cash":1393.22,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ UROGRAPHY","code_information":[{"code":"13575","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1127.24,"discounted_cash":563.62,"setting":"both","billing_class":"facility"}]},{"description":"SP CHG NEPHRO TUBE","code_information":[{"code":"13576","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1070.24,"discounted_cash":535.12,"setting":"both","billing_class":"facility"}]},{"description":"SP CHG NEPHURET STNT","code_information":[{"code":"13578","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2786.44,"discounted_cash":1393.22,"setting":"both","billing_class":"facility"}]},{"description":"SP PLMT NEPHURTR STN","code_information":[{"code":"13579","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3039.75,"discounted_cash":1519.88,"setting":"both","billing_class":"facility"}]},{"description":"SP RFA  RENAL TUMOR","code_information":[{"code":"13580","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":7220.74,"discounted_cash":3610.37,"setting":"both","billing_class":"facility"}]},{"description":"SP URETERAL BRUSH/BX","code_information":[{"code":"13583","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.85,"discounted_cash":410.43,"setting":"both","billing_class":"facility"}]},{"description":"SP INS SUPRAPUB CATH","code_information":[{"code":"13587","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3000.46,"discounted_cash":1500.23,"setting":"both","billing_class":"facility"}]},{"description":"SP BX THYROID","code_information":[{"code":"13588","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1418.59,"discounted_cash":709.29,"setting":"both","billing_class":"facility"}]},{"description":"SP ASP INJ RENAL CYS","code_information":[{"code":"13589","type":"CDM"},{"code":"320","type":"RC"},{"code":"74470","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1655.44,"discounted_cash":827.72,"setting":"both","billing_class":"facility"}]},{"description":"SP LUMBAR PUNC","code_information":[{"code":"13593","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1851.74,"discounted_cash":925.87,"setting":"both","billing_class":"facility"}]},{"description":"SP DRN CFS","code_information":[{"code":"13594","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1851.74,"discounted_cash":925.87,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ BLD PTCH/CLOT","code_information":[{"code":"13595","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2315.3,"discounted_cash":1157.65,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ NEUROLYTIC LS","code_information":[{"code":"13596","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2023.33,"discounted_cash":1011.66,"setting":"both","billing_class":"facility"}]},{"description":"SP EPIDURAL C/T","code_information":[{"code":"13599","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2051.86,"discounted_cash":1025.93,"setting":"both","billing_class":"facility"}]},{"description":"SP EPIDURAL L/S","code_information":[{"code":"13601","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2462.23,"discounted_cash":1231.12,"setting":"both","billing_class":"facility"}]},{"description":"SP REM SPINE ELECTRD","code_information":[{"code":"13602","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2279.82,"discounted_cash":1139.91,"setting":"both","billing_class":"facility"}]},{"description":"SP IMP NEURO LEAD","code_information":[{"code":"13603","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":13483.95,"discounted_cash":6741.98,"setting":"both","billing_class":"facility"}]},{"description":"SP ANALYSIS NEURO HR","code_information":[{"code":"13604","type":"CDM"},{"code":"920","type":"RC"},{"code":"95972","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.93,"discounted_cash":227.97,"setting":"both","billing_class":"facility"}]},{"description":"SP INS/REV SPINE GEN","code_information":[{"code":"13606","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":68721.81,"discounted_cash":34360.9,"setting":"both","billing_class":"facility"}]},{"description":"SP ANALIZE NEURO 60","code_information":[{"code":"13607","type":"CDM"},{"code":"920","type":"RC"},{"code":"95972","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":569.94,"discounted_cash":284.97,"setting":"both","billing_class":"facility"}]},{"description":"SP NRV BLK OCCIPIT","code_information":[{"code":"13608","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1286.87,"discounted_cash":643.43,"setting":"both","billing_class":"facility"}]},{"description":"SP NRV BLK INTERCST","code_information":[{"code":"13609","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.88,"discounted_cash":930.94,"setting":"both","billing_class":"facility"}]},{"description":"SP NRV BLK INTRCST M","code_information":[{"code":"13610","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.52,"discounted_cash":804.26,"setting":"both","billing_class":"facility"}]},{"description":"SP NRV BLK ILIOING","code_information":[{"code":"13611","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.88,"discounted_cash":930.94,"setting":"both","billing_class":"facility"}]},{"description":"SP NRV BLK SCIATIC","code_information":[{"code":"13612","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1872.01,"discounted_cash":936.0,"setting":"both","billing_class":"facility"}]},{"description":"SP NRV BLK FEM SGL","code_information":[{"code":"13613","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1713.7,"discounted_cash":856.85,"setting":"both","billing_class":"facility"}]},{"description":"SP NRV BLK OTH PERIP","code_information":[{"code":"13614","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1207.03,"discounted_cash":603.51,"setting":"both","billing_class":"facility"}]},{"description":"SP TRSF EPI C/T","code_information":[{"code":"13615","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2023.33,"discounted_cash":1011.66,"setting":"both","billing_class":"facility"}]},{"description":"SP TRSF EPI L/S","code_information":[{"code":"13617","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2023.33,"discounted_cash":1011.66,"setting":"both","billing_class":"facility"}]},{"description":"SP TRSF EPI L/S ADD","code_information":[{"code":"13618","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1630.1,"discounted_cash":815.05,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ FC JT C/T 1LV","code_information":[{"code":"13619","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2718.05,"discounted_cash":1359.03,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ FC JT C/T 2LV","code_information":[{"code":"13620","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1212.15,"discounted_cash":606.08,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ FC JT C/T 3LV","code_information":[{"code":"13621","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1119.61,"discounted_cash":559.8,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ FC JT L/S 1LV","code_information":[{"code":"13622","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2718.05,"discounted_cash":1359.03,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ FC JT L/S 2LV","code_information":[{"code":"13623","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1212.15,"discounted_cash":606.08,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ FC JT L/S 3LV","code_information":[{"code":"13624","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1128.5,"discounted_cash":564.25,"setting":"both","billing_class":"facility"}]},{"description":"SP NRV BLK ST GANGL","code_information":[{"code":"13625","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2148.1,"discounted_cash":1074.05,"setting":"both","billing_class":"facility"}]},{"description":"SP NRV BLK L/T","code_information":[{"code":"13626","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2148.1,"discounted_cash":1074.05,"setting":"both","billing_class":"facility"}]},{"description":"SP NRV BLK CELIAC PE","code_information":[{"code":"13627","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2417.92,"discounted_cash":1208.96,"setting":"both","billing_class":"facility"}]},{"description":"SP ADDTL MOD SED 15M","code_information":[{"code":"13628","type":"CDM"},{"code":"371","type":"RC"},{"code":"99153","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":213.13,"discounted_cash":106.56,"setting":"both","billing_class":"facility"}]},{"description":"SP US GUIDED JNT INJ","code_information":[{"code":"13629","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":930.6,"discounted_cash":465.3,"setting":"both","billing_class":"facility"}]},{"description":"HANDLE COIL DETACH","code_information":[{"code":"13630","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":653.25,"discounted_cash":326.63,"setting":"both","billing_class":"facility"}]},{"description":"CATH MICRO LANTERN","code_information":[{"code":"13631","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":863.5,"setting":"both","billing_class":"facility"}]},{"description":"SP SI JOINT INJ PRON","code_information":[{"code":"13634","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1945.48,"discounted_cash":972.74,"setting":"both","billing_class":"facility"}]},{"description":"SP DSTR NRV C/T 1ST","code_information":[{"code":"13637","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3540.04,"discounted_cash":1770.02,"setting":"both","billing_class":"facility"}]},{"description":"SP DSTR NRV C/T ADDL","code_information":[{"code":"13638","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":421.76,"discounted_cash":210.88,"setting":"both","billing_class":"facility"}]},{"description":"SP DSTR NRV L/S 1ST","code_information":[{"code":"13639","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3540.04,"discounted_cash":1770.02,"setting":"both","billing_class":"facility"}]},{"description":"SP RFA NRV/BRCH OTH","code_information":[{"code":"13640","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.44,"discounted_cash":647.22,"setting":"both","billing_class":"facility"}]},{"description":"SP DSTR NRV L/S ADDL","code_information":[{"code":"13641","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1019.55,"discounted_cash":509.77,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ NEUROLYT NRV","code_information":[{"code":"13642","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2677.55,"discounted_cash":1338.78,"setting":"both","billing_class":"facility"}]},{"description":"SP RHIZOTOMY SI JT","code_information":[{"code":"13643","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2183.58,"discounted_cash":1091.79,"setting":"both","billing_class":"facility"}]},{"description":"SP MYELOGRAPHY LS","code_information":[{"code":"13645","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2619.29,"discounted_cash":1309.64,"setting":"both","billing_class":"facility"}]},{"description":"SP MYELOGRAPHY CS","code_information":[{"code":"13646","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2619.29,"discounted_cash":1309.64,"setting":"both","billing_class":"facility"}]},{"description":"SP MYELOGRAPHY TS","code_information":[{"code":"13647","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1860.62,"discounted_cash":930.31,"setting":"both","billing_class":"facility"}]},{"description":"SP CONTRST XRAY HIP","code_information":[{"code":"13652","type":"CDM"},{"code":"320","type":"RC"},{"code":"73525","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":949.96,"discounted_cash":474.98,"setting":"both","billing_class":"facility"}]},{"description":"SP PERITONEOGRAM","code_information":[{"code":"13653","type":"CDM"},{"code":"320","type":"RC"},{"code":"74190","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":873.88,"discounted_cash":436.94,"setting":"both","billing_class":"facility"}]},{"description":"SP DIL BILIARY STNT","code_information":[{"code":"13656","type":"CDM"},{"code":"320","type":"RC"},{"code":"74363","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2104.0,"discounted_cash":1052.0,"setting":"both","billing_class":"facility"}]},{"description":"SP BILSTNT NEW WO SE","code_information":[{"code":"13657","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":7852.76,"discounted_cash":3926.38,"setting":"both","billing_class":"facility"}]},{"description":"SP BILSTNT NEW SEP D","code_information":[{"code":"13658","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":7852.76,"discounted_cash":3926.38,"setting":"both","billing_class":"facility"}]},{"description":"SP UROGRAPHY ANTE","code_information":[{"code":"13659","type":"CDM"},{"code":"320","type":"RC"},{"code":"74425","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":949.96,"discounted_cash":474.98,"setting":"both","billing_class":"facility"}]},{"description":"SP INS URTRL STNT PX","code_information":[{"code":"13662","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4148.02,"discounted_cash":2074.01,"setting":"both","billing_class":"facility"}]},{"description":"SP INS URTRL STNT NW","code_information":[{"code":"13663","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4148.6,"discounted_cash":2074.3,"setting":"both","billing_class":"facility"}]},{"description":"SP INS URTL STNT SEP","code_information":[{"code":"13664","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4148.02,"discounted_cash":2074.01,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ PX NEPH URETR","code_information":[{"code":"13665","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1070.24,"discounted_cash":535.12,"setting":"both","billing_class":"facility"}]},{"description":"SP GU DILATION S&I","code_information":[{"code":"13666","type":"CDM"},{"code":"320","type":"RC"},{"code":"74485","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2020.4,"discounted_cash":1010.2,"setting":"both","billing_class":"facility"}]},{"description":"SP AORTOGRPH THRC WO","code_information":[{"code":"13667","type":"CDM"},{"code":"323","type":"RC"},{"code":"75600","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5699.59,"discounted_cash":2849.8,"setting":"both","billing_class":"facility"}]},{"description":"SP AORTOGRPH THRC W","code_information":[{"code":"13668","type":"CDM"},{"code":"323","type":"RC"},{"code":"75605","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6054.26,"discounted_cash":3027.13,"setting":"both","billing_class":"facility"}]},{"description":"SP AORTOGRAM WC","code_information":[{"code":"13669","type":"CDM"},{"code":"323","type":"RC"},{"code":"75625","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4432.99,"discounted_cash":2216.49,"setting":"both","billing_class":"facility"}]},{"description":"SP AORTAGRM LE ART","code_information":[{"code":"13670","type":"CDM"},{"code":"323","type":"RC"},{"code":"75630","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4432.99,"discounted_cash":2216.49,"setting":"both","billing_class":"facility"}]},{"description":"SP CATH PLC VERT ART","code_information":[{"code":"13671","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":9126.93,"discounted_cash":4563.47,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO ADMIN CNS","code_information":[{"code":"13672","type":"CDM"},{"code":"335","type":"RC"},{"code":"96450","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":616.81,"discounted_cash":308.4,"setting":"both","billing_class":"facility"}]},{"description":"COIL RUBY SM MM","code_information":[{"code":"13674","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2693.02,"discounted_cash":1346.51,"setting":"both","billing_class":"facility"}]},{"description":"COIL RUBY MED MM","code_information":[{"code":"13675","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3464.33,"discounted_cash":1732.16,"setting":"both","billing_class":"facility"}]},{"description":"COIL RUBY LG MM","code_information":[{"code":"13676","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3464.18,"discounted_cash":1732.09,"setting":"both","billing_class":"facility"}]},{"description":"COIL POD4,5,6,8","code_information":[{"code":"13677","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.53,"discounted_cash":2309.26,"setting":"both","billing_class":"facility"}]},{"description":"SP CATH PLC EXT CARO","code_information":[{"code":"13678","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":9126.93,"discounted_cash":4563.47,"setting":"both","billing_class":"facility"}]},{"description":"COIL J SOFT POD 5-15","code_information":[{"code":"13680","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"COIL J SOFT POD30-60","code_information":[{"code":"13681","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP FILTER VENA CAVA","code_information":[{"code":"13682","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":531.38,"discounted_cash":265.69,"setting":"both","billing_class":"facility"}]},{"description":"SP CATH PLC W/INTRA","code_information":[{"code":"13683","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":8907.79,"discounted_cash":4453.9,"setting":"both","billing_class":"facility"}]},{"description":"STENT PULSAR","code_information":[{"code":"13684","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1668.29,"discounted_cash":834.14,"setting":"both","billing_class":"facility"}]},{"description":"WIRE PROWATER FLEX S","code_information":[{"code":"13685","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":247.25,"discounted_cash":123.63,"setting":"both","billing_class":"facility"}]},{"description":"SP CATH PLC TH AORTA","code_information":[{"code":"13686","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6380.98,"discounted_cash":3190.49,"setting":"both","billing_class":"facility"}]},{"description":"SP SP CATH PLC ICA","code_information":[{"code":"13687","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":11182.55,"discounted_cash":5591.27,"setting":"both","billing_class":"facility"}]},{"description":"SP CATH PLC CC/EXTRA","code_information":[{"code":"13688","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5580.51,"discounted_cash":2790.26,"setting":"both","billing_class":"facility"}]},{"description":"SP CATH PLC SUBC ART","code_information":[{"code":"13689","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5580.51,"discounted_cash":2790.26,"setting":"both","billing_class":"facility"}]},{"description":"SP CATH IV SNT/DIA","code_information":[{"code":"13690","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1571.78,"discounted_cash":785.89,"setting":"both","billing_class":"facility"}]},{"description":"SP ANGIO EXT UNI","code_information":[{"code":"13692","type":"CDM"},{"code":"323","type":"RC"},{"code":"75710","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5243.6,"discounted_cash":2621.8,"setting":"both","billing_class":"facility"}]},{"description":"ECHO EXAM OF ABDOMEN","code_information":[{"code":"13693","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":886.58,"discounted_cash":443.29,"setting":"both","billing_class":"facility"}]},{"description":"SP ANGIO EXT BIL","code_information":[{"code":"13694","type":"CDM"},{"code":"323","type":"RC"},{"code":"75716","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4432.99,"discounted_cash":2216.49,"setting":"both","billing_class":"facility"}]},{"description":"SP ANGIO VISCERAL","code_information":[{"code":"13697","type":"CDM"},{"code":"323","type":"RC"},{"code":"75726","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6054.26,"discounted_cash":3027.13,"setting":"both","billing_class":"facility"}]},{"description":"SP ANGIO PELVIS","code_information":[{"code":"13700","type":"CDM"},{"code":"323","type":"RC"},{"code":"75736","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6054.26,"discounted_cash":3027.13,"setting":"both","billing_class":"facility"}]},{"description":"SP ANGIO SEL EA ADD","code_information":[{"code":"13702","type":"CDM"},{"code":"323","type":"RC"},{"code":"75774","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1721.27,"discounted_cash":860.63,"setting":"both","billing_class":"facility"}]},{"description":"SP VENO EXT UNI","code_information":[{"code":"13704","type":"CDM"},{"code":"320","type":"RC"},{"code":"75820","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1739.04,"discounted_cash":869.52,"setting":"both","billing_class":"facility"}]},{"description":"SP VENO EXT BIL","code_information":[{"code":"13705","type":"CDM"},{"code":"320","type":"RC"},{"code":"75822","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2067.06,"discounted_cash":1033.53,"setting":"both","billing_class":"facility"}]},{"description":"SP VENO CAVAL INF","code_information":[{"code":"13706","type":"CDM"},{"code":"320","type":"RC"},{"code":"75825","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5738.83,"discounted_cash":2869.41,"setting":"both","billing_class":"facility"}]},{"description":"SP VENO CAVAL SUP","code_information":[{"code":"13707","type":"CDM"},{"code":"320","type":"RC"},{"code":"75827","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2165.87,"discounted_cash":1082.93,"setting":"both","billing_class":"facility"}]},{"description":"SP VENO RENAL U/S","code_information":[{"code":"13708","type":"CDM"},{"code":"320","type":"RC"},{"code":"75831","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5503.23,"discounted_cash":2751.61,"setting":"both","billing_class":"facility"}]},{"description":"SP VENO RENAL B/S","code_information":[{"code":"13709","type":"CDM"},{"code":"320","type":"RC"},{"code":"75833","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6728.34,"discounted_cash":3364.17,"setting":"both","billing_class":"facility"}]},{"description":"SP VENO ADRENAL U/S","code_information":[{"code":"13710","type":"CDM"},{"code":"320","type":"RC"},{"code":"75840","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6728.34,"discounted_cash":3364.17,"setting":"both","billing_class":"facility"}]},{"description":"SP VENO ADRENAL B/S","code_information":[{"code":"13711","type":"CDM"},{"code":"320","type":"RC"},{"code":"75842","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":11182.55,"discounted_cash":5591.27,"setting":"both","billing_class":"facility"}]},{"description":"SP VENO SINUS/JUG","code_information":[{"code":"13712","type":"CDM"},{"code":"320","type":"RC"},{"code":"75860","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6728.34,"discounted_cash":3364.17,"setting":"both","billing_class":"facility"}]},{"description":"SP VENOUS TBA ADD","code_information":[{"code":"13713","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6554.55,"discounted_cash":3277.28,"setting":"both","billing_class":"facility"}]},{"description":"SP VENOUS TBA INT","code_information":[{"code":"13714","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":13750.21,"discounted_cash":6875.1,"setting":"both","billing_class":"facility"}]},{"description":"SP TC EMBOLIZATION","code_information":[{"code":"13715","type":"CDM"},{"code":"320","type":"RC"},{"code":"75894","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1719.97,"discounted_cash":859.99,"setting":"both","billing_class":"facility"}]},{"description":"SP ANGIO FU TC THERA","code_information":[{"code":"13717","type":"CDM"},{"code":"323","type":"RC"},{"code":"75898","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.86,"discounted_cash":949.93,"setting":"both","billing_class":"facility"}]},{"description":"SP RMV CVA S&I","code_information":[{"code":"13719","type":"CDM"},{"code":"320","type":"RC"},{"code":"75901","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1310.9,"discounted_cash":655.45,"setting":"both","billing_class":"facility"}]},{"description":"SP TBA PERIPH ART","code_information":[{"code":"13723","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5895.89,"discounted_cash":2947.95,"setting":"both","billing_class":"facility"}]},{"description":"SP CHGE PERC TUBE","code_information":[{"code":"13730","type":"CDM"},{"code":"320","type":"RC"},{"code":"75984","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":671.31,"discounted_cash":335.65,"setting":"both","billing_class":"facility"}]},{"description":"SP PERC PLC DRN ABS","code_information":[{"code":"13731","type":"CDM"},{"code":"320","type":"RC"},{"code":"75989","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1312.31,"discounted_cash":656.15,"setting":"both","billing_class":"facility"}]},{"description":"SP FLUORO UPTO 1HR","code_information":[{"code":"13732","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":563.62,"discounted_cash":281.81,"setting":"both","billing_class":"facility"}]},{"description":"SPFISTULAGRAM","code_information":[{"code":"13733","type":"CDM"},{"code":"320","type":"RC"},{"code":"76080","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":981.62,"discounted_cash":490.81,"setting":"both","billing_class":"facility"}]},{"description":"SP FLUOROSCOPIC PROC","code_information":[{"code":"13734","type":"CDM"},{"code":"320","type":"RC"},{"code":"76496","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.12,"discounted_cash":150.06,"setting":"both","billing_class":"facility"}]},{"description":"SP US GUIDE VASC ACC","code_information":[{"code":"13735","type":"CDM"},{"code":"402","type":"RC"},{"code":"76937","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":447.05,"discounted_cash":223.53,"setting":"both","billing_class":"facility"}]},{"description":"SP US GUIDE NDL PLC","code_information":[{"code":"13737","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1584.48,"discounted_cash":792.24,"setting":"both","billing_class":"facility"}]},{"description":"SP FL GUIDE CV DEV","code_information":[{"code":"13738","type":"CDM"},{"code":"320","type":"RC"},{"code":"77001","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":459.75,"discounted_cash":229.88,"setting":"both","billing_class":"facility"}]},{"description":"SP FLUORO NDL LOC","code_information":[{"code":"13739","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1193.08,"discounted_cash":596.54,"setting":"both","billing_class":"facility"}]},{"description":"SP FL GUIDE SPINE","code_information":[{"code":"13740","type":"CDM"},{"code":"320","type":"RC"},{"code":"77003","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":576.27,"discounted_cash":288.13,"setting":"both","billing_class":"facility"}]},{"description":"SP CT GUIDE TISS ABL","code_information":[{"code":"13741","type":"CDM"},{"code":"350","type":"RC"},{"code":"77013","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1579.41,"discounted_cash":789.71,"setting":"both","billing_class":"facility"}]},{"description":"SP BLOOD GASES","code_information":[{"code":"13743","type":"CDM"},{"code":"300","type":"RC"},{"code":"82803","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":175.75,"discounted_cash":87.88,"setting":"both","billing_class":"facility"}]},{"description":"SP RIGHT HEART CATH","code_information":[{"code":"13746","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5793.32,"discounted_cash":2896.66,"setting":"both","billing_class":"facility"}]},{"description":"SP INTL MOD SEDATION","code_information":[{"code":"13747","type":"CDM"},{"code":"371","type":"RC"},{"code":"99152","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":305.24,"discounted_cash":152.62,"setting":"both","billing_class":"facility"}]},{"description":"SP SACROPLASTY UNI","code_information":[{"code":"13748","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":13228.13,"discounted_cash":6614.06,"setting":"both","billing_class":"facility"}]},{"description":"SP SACROPLASTY BIL","code_information":[{"code":"13749","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":13228.13,"discounted_cash":6614.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP NEUROSTIM TRIAL","code_information":[{"code":"13750","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":8820.79,"discounted_cash":4410.4,"setting":"both","billing_class":"facility"}]},{"description":"SP INJ SI JT ANES","code_information":[{"code":"13751","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1712.44,"discounted_cash":856.22,"setting":"both","billing_class":"facility"}]},{"description":"SP LOCM 300-399MG/ML","code_information":[{"code":"13753","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":1.1,"setting":"both","billing_class":"facility"}]},{"description":"ADDITIONAL VEIN EACH","code_information":[{"code":"13755","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":13679.0,"discounted_cash":6839.5,"setting":"both","billing_class":"facility"}]},{"description":"SP EMBO ART TUMOR","code_information":[{"code":"13756","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":16725.12,"discounted_cash":8362.56,"setting":"both","billing_class":"facility"}]},{"description":"IVUS INITIAL VESSEL","code_information":[{"code":"13758","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":8690.95,"discounted_cash":4345.48,"setting":"both","billing_class":"facility"}]},{"description":"IVUS ADDTL VESSEL","code_information":[{"code":"13759","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":8690.95,"discounted_cash":4345.48,"setting":"both","billing_class":"facility"}]},{"description":"SP SUP HYPOGAST PLEX","code_information":[{"code":"13760","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2023.33,"discounted_cash":1011.66,"setting":"both","billing_class":"facility"}]},{"description":"STENT URET COPE .038","code_information":[{"code":"13761","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":263.6,"discounted_cash":131.8,"setting":"both","billing_class":"facility"}]},{"description":"STENT PERC GLIDE 24C","code_information":[{"code":"13762","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":423.12,"discounted_cash":211.56,"setting":"both","billing_class":"facility"}]},{"description":"GRAFT FLAIR VARIOUS","code_information":[{"code":"13763","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5216.9,"discounted_cash":2608.45,"setting":"both","billing_class":"facility"}]},{"description":"GRAFT  FLAIR VARIOUS","code_information":[{"code":"13764","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5008.27,"discounted_cash":2504.14,"setting":"both","billing_class":"facility"}]},{"description":"STENT WALL VARIOUS","code_information":[{"code":"13765","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2976.79,"discounted_cash":1488.39,"setting":"both","billing_class":"facility"}]},{"description":"STENT WALL 18X60X11","code_information":[{"code":"13766","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2174.44,"discounted_cash":1087.22,"setting":"both","billing_class":"facility"}]},{"description":"FILTER VENA CAVA","code_information":[{"code":"13767","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2069.41,"discounted_cash":1034.7,"setting":"both","billing_class":"facility"}]},{"description":"FILTER DENA JUGULAR","code_information":[{"code":"13768","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2294.09,"discounted_cash":1147.05,"setting":"both","billing_class":"facility"}]},{"description":"STENT TRACH FLUENCY","code_information":[{"code":"13769","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4388.69,"discounted_cash":2194.34,"setting":"both","billing_class":"facility"}]},{"description":"COIL NESTER VARIOUS","code_information":[{"code":"13770","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.08,"discounted_cash":113.54,"setting":"both","billing_class":"facility"}]},{"description":"STENT ILIAC VARIOUS","code_information":[{"code":"13771","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":7171.52,"discounted_cash":3585.76,"setting":"both","billing_class":"facility"}]},{"description":"STENT HEPRIN 6X25","code_information":[{"code":"13772","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":10630.94,"discounted_cash":5315.47,"setting":"both","billing_class":"facility"}]},{"description":"STENT HEPRIN VARIOUS","code_information":[{"code":"13773","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":7293.32,"discounted_cash":3646.66,"setting":"both","billing_class":"facility"}]},{"description":"STENT HEPRIN 6X5","code_information":[{"code":"13774","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6373.61,"discounted_cash":3186.8,"setting":"both","billing_class":"facility"}]},{"description":"STENT HEPRIN 6X15","code_information":[{"code":"13775","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":7769.94,"discounted_cash":3884.97,"setting":"both","billing_class":"facility"}]},{"description":"STENT HEPRIN VARIOUS","code_information":[{"code":"13776","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6834.14,"discounted_cash":3417.07,"setting":"both","billing_class":"facility"}]},{"description":"STENT HEPRIN 8X10","code_information":[{"code":"13777","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":7470.65,"discounted_cash":3735.32,"setting":"both","billing_class":"facility"}]},{"description":"STENT HEPRIN VARIOUS","code_information":[{"code":"13778","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6174.07,"discounted_cash":3087.03,"setting":"both","billing_class":"facility"}]},{"description":"STENT HEPRIN 9X10","code_information":[{"code":"13779","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6772.54,"discounted_cash":3386.27,"setting":"both","billing_class":"facility"}]},{"description":"FILTER COOK IVC","code_information":[{"code":"13780","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2234.78,"discounted_cash":1117.39,"setting":"both","billing_class":"facility"}]},{"description":"STENT URET VARIOUS","code_information":[{"code":"13781","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":291.76,"discounted_cash":145.88,"setting":"both","billing_class":"facility"}]},{"description":"STENT NEPH VARIOUS","code_information":[{"code":"13782","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":251.06,"discounted_cash":125.53,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE COIL","code_information":[{"code":"13783","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":613.05,"discounted_cash":306.52,"setting":"both","billing_class":"facility"}]},{"description":"STENT ICAST 6X22X120","code_information":[{"code":"13784","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5017.05,"discounted_cash":2508.53,"setting":"both","billing_class":"facility"}]},{"description":"STENT ICAST 8X38X80","code_information":[{"code":"13785","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5294.75,"discounted_cash":2647.38,"setting":"both","billing_class":"facility"}]},{"description":"STENT ICAST 8X59X80","code_information":[{"code":"13786","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5136.7,"discounted_cash":2568.35,"setting":"both","billing_class":"facility"}]},{"description":"BALN ATLAS VARIOUS","code_information":[{"code":"13787","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":678.99,"discounted_cash":339.5,"setting":"both","billing_class":"facility"}]},{"description":"BALN ATLAS 22X4","code_information":[{"code":"13788","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":949.96,"discounted_cash":474.98,"setting":"both","billing_class":"facility"}]},{"description":"BALN ATLAS 24X4","code_information":[{"code":"13789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1203.27,"discounted_cash":601.63,"setting":"both","billing_class":"facility"}]},{"description":"BALN CONQUEST VARI","code_information":[{"code":"13790","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":553.48,"discounted_cash":276.74,"setting":"both","billing_class":"facility"}]},{"description":"GRAFT FLAIR 8X50","code_information":[{"code":"13791","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4987.11,"discounted_cash":2493.55,"setting":"both","billing_class":"facility"}]},{"description":"GRAFT FLAIR VARIOUS","code_information":[{"code":"13792","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4787.62,"discounted_cash":2393.81,"setting":"both","billing_class":"facility"}]},{"description":"STENT FLUENCY VARI","code_information":[{"code":"13793","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4388.69,"discounted_cash":2194.34,"setting":"both","billing_class":"facility"}]},{"description":"STENT FLUENCY 10X60","code_information":[{"code":"13794","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4189.14,"discounted_cash":2094.57,"setting":"both","billing_class":"facility"}]},{"description":"STENT FLUENCY 8X50","code_information":[{"code":"13795","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4588.12,"discounted_cash":2294.06,"setting":"both","billing_class":"facility"}]},{"description":"STENT FLUENCY 7X40","code_information":[{"code":"13796","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5008.27,"discounted_cash":2504.14,"setting":"both","billing_class":"facility"}]},{"description":"COIL EMBOL VARIOUS","code_information":[{"code":"13797","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1253.79,"discounted_cash":626.89,"setting":"both","billing_class":"facility"}]},{"description":"CATH ENT VARIOUS","code_information":[{"code":"13798","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3790.16,"discounted_cash":1895.08,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE ENT ST","code_information":[{"code":"13799","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.6,"discounted_cash":348.3,"setting":"both","billing_class":"facility"}]},{"description":"STENT ZILVER 6X40","code_information":[{"code":"13800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2451.99,"discounted_cash":1225.99,"setting":"both","billing_class":"facility"}]},{"description":"STENT ZILVER 6X60","code_information":[{"code":"13801","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3119.69,"discounted_cash":1559.85,"setting":"both","billing_class":"facility"}]},{"description":"STENT ZILVER VARIOUS","code_information":[{"code":"13802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3581.48,"discounted_cash":1790.74,"setting":"both","billing_class":"facility"}]},{"description":"STENT ZILVER 6X120","code_information":[{"code":"13803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4163.12,"discounted_cash":2081.56,"setting":"both","billing_class":"facility"}]},{"description":"STENT PERI VARIOUS","code_information":[{"code":"13804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2322.67,"discounted_cash":1161.34,"setting":"both","billing_class":"facility"}]},{"description":"STENT PERIPH VARIOUS","code_information":[{"code":"13805","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2722.96,"discounted_cash":1361.48,"setting":"both","billing_class":"facility"}]},{"description":"STENT PERI 6X150X5","code_information":[{"code":"13806","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2962.37,"discounted_cash":1481.18,"setting":"both","billing_class":"facility"}]},{"description":"STENT PERI VARIOUS","code_information":[{"code":"13807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2639.15,"discounted_cash":1319.58,"setting":"both","billing_class":"facility"}]},{"description":"STENT WALL VARIOUS","code_information":[{"code":"13808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1986.23,"discounted_cash":993.12,"setting":"both","billing_class":"facility"}]},{"description":"STENT WALL VARIOUS","code_information":[{"code":"13809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2846.01,"discounted_cash":1423.01,"setting":"both","billing_class":"facility"}]},{"description":"STENT WALL VARIOUS","code_information":[{"code":"13810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2214.46,"discounted_cash":1107.23,"setting":"both","billing_class":"facility"}]},{"description":"CATH ANGIOJET 6X90","code_information":[{"code":"13811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3096.75,"discounted_cash":1548.38,"setting":"both","billing_class":"facility"}]},{"description":"CATH ANGIOJET 6X120","code_information":[{"code":"13812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3286.73,"discounted_cash":1643.37,"setting":"both","billing_class":"facility"}]},{"description":"CATH ANGIOJET 4X145","code_information":[{"code":"13813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4084.7,"discounted_cash":2042.35,"setting":"both","billing_class":"facility"}]},{"description":"KIT POWER PULSE","code_information":[{"code":"13814","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.25,"discounted_cash":53.63,"setting":"both","billing_class":"facility"}]},{"description":"CATH DIAM VARIOUS","code_information":[{"code":"13815","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1724","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6747.2,"discounted_cash":3373.6,"setting":"both","billing_class":"facility"}]},{"description":"WIRE VIPER","code_information":[{"code":"13816","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1738.93,"discounted_cash":869.47,"setting":"both","billing_class":"facility"}]},{"description":"LUBRICANT VIPERSLIDE","code_information":[{"code":"13817","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":255.45,"discounted_cash":127.72,"setting":"both","billing_class":"facility"}]},{"description":"CATH INDIGO 6X132","code_information":[{"code":"13818","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2365.31,"discounted_cash":1182.65,"setting":"both","billing_class":"facility"}]},{"description":"CATH INDIGO 6X135","code_information":[{"code":"13819","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":7763.83,"discounted_cash":3881.91,"setting":"both","billing_class":"facility"}]},{"description":"CATH INDIGO 8X85","code_information":[{"code":"13820","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5862.82,"discounted_cash":2931.41,"setting":"both","billing_class":"facility"}]},{"description":"SEPARATOR INDIGO 5","code_information":[{"code":"13821","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1622.6,"discounted_cash":811.3,"setting":"both","billing_class":"facility"}]},{"description":"SEPARATOR INDIGO 6","code_information":[{"code":"13822","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2118.65,"discounted_cash":1059.33,"setting":"both","billing_class":"facility"}]},{"description":"SEPARATOR INDIGO 8","code_information":[{"code":"13823","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3718.05,"discounted_cash":1859.03,"setting":"both","billing_class":"facility"}]},{"description":"TUBING INDIGO ASP","code_information":[{"code":"13824","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.45,"discounted_cash":559.23,"setting":"both","billing_class":"facility"}]},{"description":"CANISTER INDIGO MAX","code_information":[{"code":"13825","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":905.15,"discounted_cash":452.57,"setting":"both","billing_class":"facility"}]},{"description":"TUBING ASP LG LUMEN","code_information":[{"code":"13826","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5230.05,"discounted_cash":2615.03,"setting":"both","billing_class":"facility"}]},{"description":"SEPARATOR D","code_information":[{"code":"13827","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3337.7,"discounted_cash":1668.85,"setting":"both","billing_class":"facility"}]},{"description":"BALN CATH DC VARI","code_information":[{"code":"13828","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2623","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2963.78,"discounted_cash":1481.89,"setting":"both","billing_class":"facility"}]},{"description":"BALN CATH DC VARI","code_information":[{"code":"13829","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2623","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2678.81,"discounted_cash":1339.4,"setting":"both","billing_class":"facility"}]},{"description":"BALN CATH DC VARI","code_information":[{"code":"13830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2623","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3134.79,"discounted_cash":1567.39,"setting":"both","billing_class":"facility"}]},{"description":"BALN CATH DC VARI","code_information":[{"code":"13831","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2623","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3248.75,"discounted_cash":1624.38,"setting":"both","billing_class":"facility"}]},{"description":"KIT VETEBRAL CEMENT","code_information":[{"code":"13832","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2623","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1466.19,"discounted_cash":733.1,"setting":"both","billing_class":"facility"}]},{"description":"SP SCLEROTHERAPY","code_information":[{"code":"13833","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1852.47,"discounted_cash":926.24,"setting":"both","billing_class":"facility"}]},{"description":"SP CHEMO IA PUSH TEC","code_information":[{"code":"13834","type":"CDM"},{"code":"331","type":"RC"},{"code":"96420","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1090.93,"discounted_cash":545.47,"setting":"both","billing_class":"facility"}]},{"description":"SP INS TUN IP CATH","code_information":[{"code":"13835","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6039.06,"discounted_cash":3019.53,"setting":"both","billing_class":"facility"}]},{"description":"EVNT RCRDR CARDC G48","code_information":[{"code":"13836","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1764","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":11545.06,"discounted_cash":5772.53,"setting":"both","billing_class":"facility"}]},{"description":"CATH HAWKONE","code_information":[{"code":"13837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1714","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6647.87,"discounted_cash":3323.93,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM EMBOLIZATION","code_information":[{"code":"13838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2107.77,"discounted_cash":1053.88,"setting":"both","billing_class":"facility"}]},{"description":"TRANSLUMIN THRMBCTMY","code_information":[{"code":"13839","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.6,"discounted_cash":348.3,"setting":"both","billing_class":"facility"}]},{"description":"ADAPTER THOUHY BORST","code_information":[{"code":"13840","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility"}]},{"description":"BOWL SPONGE DISP","code_information":[{"code":"13841","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.13,"setting":"both","billing_class":"facility"}]},{"description":"CATH DIAG VARIOUS 5F","code_information":[{"code":"13842","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.2,"discounted_cash":18.6,"setting":"both","billing_class":"facility"}]},{"description":"CATH DIAG VARIOUS 5F","code_information":[{"code":"13843","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":29.5,"setting":"both","billing_class":"facility"}]},{"description":"CATH DRAIN VARIOUS","code_information":[{"code":"13844","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.75,"discounted_cash":103.88,"setting":"both","billing_class":"facility"}]},{"description":"CATH DRAIN VARIOUS","code_information":[{"code":"13845","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.26,"discounted_cash":86.63,"setting":"both","billing_class":"facility"}]},{"description":"CATH DRAIN SAFE T","code_information":[{"code":"13846","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1729","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.65,"discounted_cash":34.83,"setting":"both","billing_class":"facility"}]},{"description":"CATH EMBOL VARIOUS","code_information":[{"code":"13847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":148.55,"discounted_cash":74.28,"setting":"both","billing_class":"facility"}]},{"description":"CATH GLIDE VARIOUS","code_information":[{"code":"13848","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":156.54,"discounted_cash":78.27,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUDING MACH","code_information":[{"code":"13849","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":292.23,"discounted_cash":146.12,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIGING QC 150C","code_information":[{"code":"13850","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.21,"discounted_cash":234.1,"setting":"both","billing_class":"facility"}]},{"description":"CATH CROSS STANDARD","code_information":[{"code":"13851","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2184.83,"discounted_cash":1092.41,"setting":"both","billing_class":"facility"}]},{"description":"CATH GROSHONG 9.5FR","code_information":[{"code":"13852","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1751","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":507.09,"discounted_cash":253.54,"setting":"both","billing_class":"facility"}]},{"description":"CATH MOTARJEME 5X65","code_information":[{"code":"13853","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.64,"discounted_cash":21.32,"setting":"both","billing_class":"facility"}]},{"description":"CATH NAVICROSS MISC","code_information":[{"code":"13854","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":478.87,"discounted_cash":239.44,"setting":"both","billing_class":"facility"}]},{"description":"CATH QUICK MISC","code_information":[{"code":"13855","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":556.99,"discounted_cash":278.5,"setting":"both","billing_class":"facility"}]},{"description":"CATH RENEGADE FIBER","code_information":[{"code":"13856","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.84,"discounted_cash":453.92,"setting":"both","billing_class":"facility"}]},{"description":"CATH UNIFUSE VARIOUS","code_information":[{"code":"13857","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":459.75,"discounted_cash":229.88,"setting":"both","billing_class":"facility"}]},{"description":"CATH VOLCANO IVUS","code_information":[{"code":"13858","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1753","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.19,"discounted_cash":1075.1,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA ELECT GA 10M","code_information":[{"code":"13859","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.25,"discounted_cash":27.13,"setting":"both","billing_class":"facility"}]},{"description":"CONNECTOR NOMOLINE","code_information":[{"code":"13860","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.45,"discounted_cash":37.73,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE MYNXGRIP","code_information":[{"code":"13861","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":650.41,"discounted_cash":325.2,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE ANGIOSEAL","code_information":[{"code":"13862","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":639.54,"discounted_cash":319.77,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE THROMBOL 7F","code_information":[{"code":"13863","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.72,"discounted_cash":808.36,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE THROMBOL 5F","code_information":[{"code":"13864","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1314.71,"discounted_cash":657.36,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE TORQUE MULTI","code_information":[{"code":"13865","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.95,"discounted_cash":10.97,"setting":"both","billing_class":"facility"}]},{"description":"DILATOR VESSEL 4FR","code_information":[{"code":"13866","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":43.2,"discounted_cash":21.6,"setting":"both","billing_class":"facility"}]},{"description":"DILATOR VESSEL MISC","code_information":[{"code":"13867","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.3,"discounted_cash":16.65,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLE ANGIO 17G","code_information":[{"code":"13868","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.3,"discounted_cash":3.65,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLE TUOHY 20X3.5","code_information":[{"code":"13869","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.2,"discounted_cash":9.1,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLE TOUHY 20X6","code_information":[{"code":"13870","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.05,"discounted_cash":16.52,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLE SPINAL 23X5.0","code_information":[{"code":"13871","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility"}]},{"description":"NEELDE CHIBA VARIOUS","code_information":[{"code":"13872","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.75,"discounted_cash":23.88,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLE INTR EPIMED","code_information":[{"code":"13873","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":45.4,"discounted_cash":22.7,"setting":"both","billing_class":"facility"}]},{"description":"NEELDE YEUH VARIOUS","code_information":[{"code":"13874","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":45.45,"discounted_cash":22.73,"setting":"both","billing_class":"facility"}]},{"description":"NEELDE YEUH VARIOUS","code_information":[{"code":"13875","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.35,"discounted_cash":35.17,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLE OSTEO BONE","code_information":[{"code":"13876","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":149.9,"discounted_cash":74.95,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLE OSTEO BIO 15","code_information":[{"code":"13877","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":292.85,"discounted_cash":146.43,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLE AVAFLEX 11G","code_information":[{"code":"13878","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1999.85,"discounted_cash":999.92,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLE BIOPSY COAX","code_information":[{"code":"13879","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4328.45,"discounted_cash":2164.22,"setting":"both","billing_class":"facility"}]},{"description":"PAD GROUNDING NEURO","code_information":[{"code":"13880","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":23.63,"setting":"both","billing_class":"facility"}]},{"description":"PAD GROUNDING","code_information":[{"code":"13881","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.1,"discounted_cash":34.55,"setting":"both","billing_class":"facility"}]},{"description":"SET EXTTUBING 5.3X15","code_information":[{"code":"13882","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.4,"discounted_cash":13.7,"setting":"both","billing_class":"facility"}]},{"description":"SET ACKERMAN BIOPSY","code_information":[{"code":"13883","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":108.1,"discounted_cash":54.05,"setting":"both","billing_class":"facility"}]},{"description":"SET ACCESS APRIMA","code_information":[{"code":"13884","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":200.74,"discounted_cash":100.37,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH TREROTOLA","code_information":[{"code":"13885","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.42,"discounted_cash":43.21,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH MICRO 21GA","code_information":[{"code":"13886","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.24,"discounted_cash":48.12,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH PREC 5X10","code_information":[{"code":"13887","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.54,"discounted_cash":53.27,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH ST VARIOUS","code_information":[{"code":"13888","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":141.65,"discounted_cash":70.83,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH ANSEL VARIOUS","code_information":[{"code":"13889","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":160.2,"discounted_cash":80.1,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH ST VARIOUS","code_information":[{"code":"13890","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":172.06,"discounted_cash":86.03,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH GLIDE MISC","code_information":[{"code":"13891","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":184.7,"discounted_cash":92.35,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH ANSEL MISC","code_information":[{"code":"13892","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":197.82,"discounted_cash":98.91,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH ST VARIOUS","code_information":[{"code":"13893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":198.18,"discounted_cash":99.09,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH ANSEL VARIOUS","code_information":[{"code":"13894","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.13,"discounted_cash":117.56,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH ST VARIOUS","code_information":[{"code":"13895","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":306.5,"discounted_cash":153.25,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH ANG 10X40","code_information":[{"code":"13896","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":254.88,"discounted_cash":127.44,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH TRANSJUGULAR","code_information":[{"code":"13897","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1231.11,"discounted_cash":615.55,"setting":"both","billing_class":"facility"}]},{"description":"SNARE GOOSENECK","code_information":[{"code":"13898","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1773","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":673.82,"discounted_cash":336.91,"setting":"both","billing_class":"facility"}]},{"description":"SNARE VASC ATRIEVE","code_information":[{"code":"13899","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1773","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":781.71,"discounted_cash":390.86,"setting":"both","billing_class":"facility"}]},{"description":"SNARE RETR FILTER","code_information":[{"code":"13900","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1773","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":861.24,"discounted_cash":430.62,"setting":"both","billing_class":"facility"}]},{"description":"STENT ZILVER VARIOUS","code_information":[{"code":"13901","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1861.88,"discounted_cash":930.94,"setting":"both","billing_class":"facility"}]},{"description":"SYRINGE LOR 7CC","code_information":[{"code":"13902","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":9.25,"setting":"both","billing_class":"facility"}]},{"description":"STRINGE ANGIO 150ML","code_information":[{"code":"13903","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":40.6,"discounted_cash":20.3,"setting":"both","billing_class":"facility"}]},{"description":"TUBING VINYL 11.5X30","code_information":[{"code":"13904","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":12.25,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE COIL PUSH","code_information":[{"code":"13905","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":613.05,"discounted_cash":306.52,"setting":"both","billing_class":"facility"}]},{"description":"WIRE AMPLANTZ MISC","code_information":[{"code":"13906","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.91,"discounted_cash":42.45,"setting":"both","billing_class":"facility"}]},{"description":"WIRE AMPLANTZ SS 180","code_information":[{"code":"13907","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.15,"discounted_cash":65.08,"setting":"both","billing_class":"facility"}]},{"description":"WIRE AMPLANTZ US 260","code_information":[{"code":"13908","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.21,"discounted_cash":86.61,"setting":"both","billing_class":"facility"}]},{"description":"WIRE ROSEN MISC","code_information":[{"code":"13909","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.54,"discounted_cash":27.77,"setting":"both","billing_class":"facility"}]},{"description":"WIRE FIXED J 3MM","code_information":[{"code":"13910","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.61,"discounted_cash":26.8,"setting":"both","billing_class":"facility"}]},{"description":"WIRE SAFE T J MISC","code_information":[{"code":"13911","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.78,"discounted_cash":33.39,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE COPE","code_information":[{"code":"13912","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.29,"discounted_cash":52.15,"setting":"both","billing_class":"facility"}]},{"description":"WIRE GLIDE VARIOUS","code_information":[{"code":"13913","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":154.66,"discounted_cash":77.33,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE NITREX","code_information":[{"code":"13914","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":169.71,"discounted_cash":84.86,"setting":"both","billing_class":"facility"}]},{"description":"WIREGLIDE .035X260","code_information":[{"code":"13915","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":484.62,"discounted_cash":242.31,"setting":"both","billing_class":"facility"}]},{"description":"WIRE HI TOR .014X190","code_information":[{"code":"13916","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":378.34,"discounted_cash":189.17,"setting":"both","billing_class":"facility"}]},{"description":"WIRE GLIDE ANG","code_information":[{"code":"13917","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":644.24,"discounted_cash":322.12,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE FATHOM","code_information":[{"code":"13918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":708.61,"discounted_cash":354.31,"setting":"both","billing_class":"facility"}]},{"description":"WIRE GLIDE ADV","code_information":[{"code":"13919","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":426.67,"discounted_cash":213.34,"setting":"both","billing_class":"facility"}]},{"description":"WIRE GLIDE ANG .014","code_information":[{"code":"13920","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":381.32,"discounted_cash":190.66,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE TRANS .018","code_information":[{"code":"13921","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":548.42,"discounted_cash":274.21,"setting":"both","billing_class":"facility"}]},{"description":"WIRE LAUREATE 180","code_information":[{"code":"13922","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.82,"discounted_cash":48.41,"setting":"both","billing_class":"facility"}]},{"description":"WIRE LAUREATE 260","code_information":[{"code":"13923","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":112.34,"discounted_cash":56.17,"setting":"both","billing_class":"facility"}]},{"description":"WIRE LAUREATE ST 260","code_information":[{"code":"13924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":394.8,"discounted_cash":197.4,"setting":"both","billing_class":"facility"}]},{"description":"ELECTRODE RF 15CM","code_information":[{"code":"13925","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":218.15,"discounted_cash":109.08,"setting":"both","billing_class":"facility"}]},{"description":"UNIT TREROROLA OTW","code_information":[{"code":"13926","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":462.88,"discounted_cash":231.44,"setting":"both","billing_class":"facility"}]},{"description":"CATH EPIDURAL 19X61","code_information":[{"code":"13927","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4300","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.85,"discounted_cash":35.42,"setting":"both","billing_class":"facility"}]},{"description":"KIT COOLED RFA","code_information":[{"code":"13928","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4300","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2117.0,"discounted_cash":1058.5,"setting":"both","billing_class":"facility"}]},{"description":"KIT RF SINGLE 3.0X15","code_information":[{"code":"13929","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4300","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":79.2,"discounted_cash":39.6,"setting":"both","billing_class":"facility"}]},{"description":"KIT RF CLUSTER2.5X15","code_information":[{"code":"13930","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4300","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3070.1,"discounted_cash":1535.05,"setting":"both","billing_class":"facility"}]},{"description":"KIT BIOPSY NDL 11GA","code_information":[{"code":"13931","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4300","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":189.05,"discounted_cash":94.53,"setting":"both","billing_class":"facility"}]},{"description":"KIT NDL BONE CEMENT","code_information":[{"code":"13932","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4300","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":426.6,"discounted_cash":213.3,"setting":"both","billing_class":"facility"}]},{"description":"KIT AD VETEBRAL 13G","code_information":[{"code":"13933","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4300","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2211.17,"discounted_cash":1105.59,"setting":"both","billing_class":"facility"}]},{"description":"KIT VERTEBRAL 11X15","code_information":[{"code":"13934","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4300","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1996.9,"discounted_cash":998.45,"setting":"both","billing_class":"facility"}]},{"description":"STENT PERIPH VARIOUS","code_information":[{"code":"13935","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3234.54,"discounted_cash":1617.27,"setting":"both","billing_class":"facility"}]},{"description":"STENT ABSOLUTE VARIO","code_information":[{"code":"13936","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2184.99,"discounted_cash":1092.49,"setting":"both","billing_class":"facility"}]},{"description":"STENT WALL ENDO VAR","code_information":[{"code":"13937","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2938.38,"discounted_cash":1469.19,"setting":"both","billing_class":"facility"}]},{"description":"STENT SYSTEM OMNI VA","code_information":[{"code":"13938","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2342.11,"discounted_cash":1171.06,"setting":"both","billing_class":"facility"}]},{"description":"CATH DIL WH VARIOUS","code_information":[{"code":"13939","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.42,"discounted_cash":147.71,"setting":"both","billing_class":"facility"}]},{"description":"CATH DIL WH VARIOUS","code_information":[{"code":"13940","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":341.04,"discounted_cash":170.52,"setting":"both","billing_class":"facility"}]},{"description":"CATH BALN ARM PTA VA","code_information":[{"code":"13941","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.16,"discounted_cash":241.58,"setting":"both","billing_class":"facility"}]},{"description":"CATH BALN ARMADA VAR","code_information":[{"code":"13942","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":674.39,"discounted_cash":337.19,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE WILDCAT","code_information":[{"code":"13943","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3220.9,"discounted_cash":1610.45,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM ANGIASSIST","code_information":[{"code":"13944","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":278.9,"discounted_cash":139.45,"setting":"both","billing_class":"facility"}]},{"description":"GLIDEWIRE HEPRIN 1","code_information":[{"code":"13945","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":51.99,"discounted_cash":26.0,"setting":"both","billing_class":"facility"}]},{"description":"KIT INTRODUCER ECHO","code_information":[{"code":"13946","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":81.5,"discounted_cash":40.75,"setting":"both","billing_class":"facility"}]},{"description":"BUTTON PERCHIK SUT","code_information":[{"code":"13947","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.6,"discounted_cash":24.3,"setting":"both","billing_class":"facility"}]},{"description":"STENT HEPRIN 150 VAR","code_information":[{"code":"13948","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":8534.88,"discounted_cash":4267.44,"setting":"both","billing_class":"facility"}]},{"description":"SET TULIP VENA CAVA","code_information":[{"code":"13949","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1773","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":626.95,"discounted_cash":313.48,"setting":"both","billing_class":"facility"}]},{"description":"SNARE 4 LOOP CLOVER","code_information":[{"code":"13950","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1773","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.43,"discounted_cash":637.22,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDE 55CM","code_information":[{"code":"13951","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":271.33,"discounted_cash":135.66,"setting":"both","billing_class":"facility"}]},{"description":"BLAN DRG COATED LXSH","code_information":[{"code":"13952","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2623","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2314.88,"discounted_cash":1157.44,"setting":"both","billing_class":"facility"}]},{"description":"BLAN DRG COATEDLXLNG","code_information":[{"code":"13953","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2623","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2992.25,"discounted_cash":1496.13,"setting":"both","billing_class":"facility"}]},{"description":"IM LEAD KIT NEURO","code_information":[{"code":"13954","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3543.6,"discounted_cash":1771.8,"setting":"both","billing_class":"facility"}]},{"description":"CABLE/EXT NEURO","code_information":[{"code":"13955","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":732.0,"discounted_cash":366.0,"setting":"both","billing_class":"facility"}]},{"description":"WRENCH HEX","code_information":[{"code":"13956","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":182.35,"discounted_cash":91.17,"setting":"both","billing_class":"facility"}]},{"description":"KIT REMOTE FREELINK","code_information":[{"code":"13957","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1787","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3375.25,"discounted_cash":1687.63,"setting":"both","billing_class":"facility"}]},{"description":"LEADS CONT PRECISION","code_information":[{"code":"13958","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4689.65,"discounted_cash":2344.82,"setting":"both","billing_class":"facility"}]},{"description":"KIT PATIENT TRIAL","code_information":[{"code":"13959","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":206.85,"discounted_cash":103.42,"setting":"both","billing_class":"facility"}]},{"description":"ANCHOR CLIK","code_information":[{"code":"13960","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1883","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1102.32,"discounted_cash":551.16,"setting":"both","billing_class":"facility"}]},{"description":"KIT TR ACCESSORY","code_information":[{"code":"13961","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1883","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.8,"discounted_cash":168.4,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLE EPIMED CR 4","code_information":[{"code":"13962","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1883","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":182.35,"discounted_cash":91.17,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE SUTURE FIXATE","code_information":[{"code":"13963","type":"CDM"},{"code":"272","type":"RC"},{"code":"L9900","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.6,"discounted_cash":1130.3,"setting":"both","billing_class":"facility"}]},{"description":"TOOL TUNNELING","code_information":[{"code":"13964","type":"CDM"},{"code":"272","type":"RC"},{"code":"L9900","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":731.6,"discounted_cash":365.8,"setting":"both","billing_class":"facility"}]},{"description":"PROGRAMMER PT NOVA","code_information":[{"code":"13965","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":33035.48,"discounted_cash":16517.74,"setting":"both","billing_class":"facility"}]},{"description":"KIT REMOTE FREELINK","code_information":[{"code":"13966","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1767","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1996.9,"discounted_cash":998.45,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM PREC CHARGE","code_information":[{"code":"13967","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8689","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4306.3,"discounted_cash":2153.15,"setting":"both","billing_class":"facility"}]},{"description":"SP PSEUDOANEURYSM","code_information":[{"code":"13968","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1940.36,"discounted_cash":970.18,"setting":"both","billing_class":"facility"}]},{"description":"SP PSEUDO COMPRESS","code_information":[{"code":"13969","type":"CDM"},{"code":"402","type":"RC"},{"code":"76936","type":"CPT"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":945.46,"discounted_cash":472.73,"setting":"both","billing_class":"facility"}]},{"description":"KIT BALLON 11GX15MM","code_information":[{"code":"13970","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2565.79,"discounted_cash":1282.89,"setting":"both","billing_class":"facility"}]},{"description":"KIT BALLOON 11GX20MM","code_information":[{"code":"13971","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2628","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":5371.51,"discounted_cash":2685.76,"setting":"both","billing_class":"facility"}]},{"description":"POWERED BONE BX NDLE","code_information":[{"code":"13972","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1830","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":487.02,"discounted_cash":243.51,"setting":"both","billing_class":"facility"}]},{"description":"STENT VIABAHN","code_information":[{"code":"13973","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":11734.78,"discounted_cash":5867.39,"setting":"both","billing_class":"facility"}]},{"description":"ABDOMEN PERITONEUM","code_information":[{"code":"13974","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4432.99,"discounted_cash":2216.49,"setting":"both","billing_class":"facility"}]},{"description":"SP GJ TUBE EXCHANGE","code_information":[{"code":"13975","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2343.15,"discounted_cash":1171.58,"setting":"both","billing_class":"facility"}]},{"description":"THORACIC/LUMBAR MYEL","code_information":[{"code":"13976","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2029.65,"discounted_cash":1014.83,"setting":"both","billing_class":"facility"}]},{"description":"BONE MARROW BX ASPIR","code_information":[{"code":"13977","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6068.16,"discounted_cash":3034.08,"setting":"both","billing_class":"facility"}]},{"description":"CATH INDIGO 5 LARGE","code_information":[{"code":"13978","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":2954.22,"discounted_cash":1477.11,"setting":"both","billing_class":"facility"}]},{"description":"CATH INDIGO 8 LARGE","code_information":[{"code":"13979","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6203.02,"discounted_cash":3101.51,"setting":"both","billing_class":"facility"}]},{"description":"CATH BALN VIATRAC VA","code_information":[{"code":"13980","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":431.9,"discounted_cash":215.95,"setting":"both","billing_class":"facility"}]},{"description":"URTRL STRCTRE BLLN D","code_information":[{"code":"13981","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":728.31,"discounted_cash":364.15,"setting":"both","billing_class":"facility"}]},{"description":"STENT VENOVO 16FR VA","code_information":[{"code":"13982","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3092.0,"discounted_cash":1546.0,"setting":"both","billing_class":"facility"}]},{"description":"STENT VENOVO 18 &20","code_information":[{"code":"13983","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":3490.93,"discounted_cash":1745.46,"setting":"both","billing_class":"facility"}]},{"description":"TCAR WO DISTAL EMBOL","code_information":[{"code":"13984","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4179.69,"discounted_cash":2089.84,"setting":"both","billing_class":"facility"}]},{"description":"TCAR W DISTAL EMBOLI","code_information":[{"code":"13985","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":4179.69,"discounted_cash":2089.84,"setting":"both","billing_class":"facility"}]},{"description":"FNA EACH ADDTL LESN","code_information":[{"code":"13986","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1076.56,"discounted_cash":538.28,"setting":"both","billing_class":"facility"}]},{"description":"WIRE ACCUSTICK II W3","code_information":[{"code":"13987","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":225.77,"discounted_cash":112.89,"setting":"both","billing_class":"facility"}]},{"description":"PAD RADIATION","code_information":[{"code":"13988","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.35,"discounted_cash":34.67,"setting":"both","billing_class":"facility"}]},{"description":"BALN CHAMELEON VAR","code_information":[{"code":"13989","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":626.95,"discounted_cash":313.48,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE SKIN CLSRE 8C","code_information":[{"code":"13990","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":218.15,"discounted_cash":109.08,"setting":"both","billing_class":"facility"}]},{"description":"STENT HEPRIN 250 VAR","code_information":[{"code":"13991","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":11171.21,"discounted_cash":5585.6,"setting":"both","billing_class":"facility"}]},{"description":"STENT HEPRIN 7 AND 8","code_information":[{"code":"13992","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":7301.15,"discounted_cash":3650.57,"setting":"both","billing_class":"facility"}]},{"description":"KIT BONE CEMENT WO","code_information":[{"code":"13993","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1484.75,"discounted_cash":742.38,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLE IVAS DIAMOND","code_information":[{"code":"13994","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":137.85,"discounted_cash":68.92,"setting":"both","billing_class":"facility"}]},{"description":"STYLET 11GA","code_information":[{"code":"13995","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":114.85,"discounted_cash":57.42,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA IVAS 11GA","code_information":[{"code":"13996","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.05,"discounted_cash":69.03,"setting":"both","billing_class":"facility"}]},{"description":"KIT BIOPSY BONE IVAS","code_information":[{"code":"13997","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":204.8,"discounted_cash":102.4,"setting":"both","billing_class":"facility"}]},{"description":"TRAY BONE MORROW LES","code_information":[{"code":"13998","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":909.05,"discounted_cash":454.52,"setting":"both","billing_class":"facility"}]},{"description":"STENT VIABBAHN EXPAN","code_information":[{"code":"13999","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":6654.82,"discounted_cash":3327.41,"setting":"both","billing_class":"facility"}]},{"description":"APPL UNNA BOOT RT","code_information":[{"code":"14","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.05,"discounted_cash":227.53,"setting":"both","billing_class":"facility"}]},{"description":"STENT VIABAHN ENDPRS","code_information":[{"code":"14000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":11144.61,"discounted_cash":5572.31,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE VASC 0.035","code_information":[{"code":"14001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.3,"discounted_cash":12.15,"setting":"both","billing_class":"facility"}]},{"description":"SP SUPRASCAPULAR NRV","code_information":[{"code":"14002","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1722.26,"discounted_cash":861.13,"setting":"both","billing_class":"facility"}]},{"description":"SP CT FLURO LP DX","code_information":[{"code":"14003","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1988.65,"discounted_cash":994.33,"setting":"both","billing_class":"facility"}]},{"description":"CT HEAD/BRAIN W/O","code_information":[{"code":"14038","type":"CDM"},{"code":"351","type":"RC"},{"code":"70450","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1600.94,"discounted_cash":800.47,"setting":"both","billing_class":"facility"}]},{"description":"CT HEAD/BRAIN W","code_information":[{"code":"14039","type":"CDM"},{"code":"351","type":"RC"},{"code":"70460","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1556.63,"discounted_cash":778.32,"setting":"both","billing_class":"facility"}]},{"description":"CT HEAD/BRAIN WW/O","code_information":[{"code":"14040","type":"CDM"},{"code":"351","type":"RC"},{"code":"70470","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2377.38,"discounted_cash":1188.69,"setting":"both","billing_class":"facility"}]},{"description":"CT SELL/ORB/IAC W/O","code_information":[{"code":"14041","type":"CDM"},{"code":"351","type":"RC"},{"code":"70480","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1600.94,"discounted_cash":800.47,"setting":"both","billing_class":"facility"}]},{"description":"CT IAC BIL W/O","code_information":[{"code":"14042","type":"CDM"},{"code":"351","type":"RC"},{"code":"70480","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1684.64,"discounted_cash":842.32,"setting":"both","billing_class":"facility"}]},{"description":"CT SELL/ORB/IAC W","code_information":[{"code":"14048","type":"CDM"},{"code":"351","type":"RC"},{"code":"70481","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1873.27,"discounted_cash":936.63,"setting":"both","billing_class":"facility"}]},{"description":"CT ORBIT W/WO","code_information":[{"code":"14054","type":"CDM"},{"code":"351","type":"RC"},{"code":"70482","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2639.57,"discounted_cash":1319.79,"setting":"both","billing_class":"facility"}]},{"description":"CT GUIDE TISS ABLAT","code_information":[{"code":"14055","type":"CDM"},{"code":"350","type":"RC"},{"code":"77013","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1579.41,"discounted_cash":789.71,"setting":"both","billing_class":"facility"}]},{"description":"CT ORBIT W/WO","code_information":[{"code":"14056","type":"CDM"},{"code":"351","type":"RC"},{"code":"70482","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2639.57,"discounted_cash":1319.79,"setting":"both","billing_class":"facility"}]},{"description":"CT IAC BIL WO/W","code_information":[{"code":"14059","type":"CDM"},{"code":"351","type":"RC"},{"code":"70482","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2639.57,"discounted_cash":1319.79,"setting":"both","billing_class":"facility"}]},{"description":"CT MAXLLFCIAL W/O","code_information":[{"code":"14060","type":"CDM"},{"code":"351","type":"RC"},{"code":"70486","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1619.91,"discounted_cash":809.96,"setting":"both","billing_class":"facility"}]},{"description":"3D REND W POST PROC","code_information":[{"code":"14065","type":"CDM"},{"code":"350","type":"RC"},{"code":"76377","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":233.04,"discounted_cash":116.52,"setting":"both","billing_class":"facility"}]},{"description":"CT MAXILLOFACIAL W","code_information":[{"code":"14066","type":"CDM"},{"code":"351","type":"RC"},{"code":"70487","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1704.81,"discounted_cash":852.4,"setting":"both","billing_class":"facility"}]},{"description":"CT MAXILLOFAC WW/O","code_information":[{"code":"14069","type":"CDM"},{"code":"351","type":"RC"},{"code":"70488","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2453.35,"discounted_cash":1226.67,"setting":"both","billing_class":"facility"}]},{"description":"CT SFT TISS/NCK W/O","code_information":[{"code":"14071","type":"CDM"},{"code":"351","type":"RC"},{"code":"70490","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1573.09,"discounted_cash":786.54,"setting":"both","billing_class":"facility"}]},{"description":"CT SFT TISS/NCK W","code_information":[{"code":"14072","type":"CDM"},{"code":"351","type":"RC"},{"code":"70491","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1946.73,"discounted_cash":973.37,"setting":"both","billing_class":"facility"}]},{"description":"CT SFT TISS/NCK W/WO","code_information":[{"code":"14073","type":"CDM"},{"code":"351","type":"RC"},{"code":"70492","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2505.28,"discounted_cash":1252.64,"setting":"both","billing_class":"facility"}]},{"description":"CTA HEAD WO/W","code_information":[{"code":"14074","type":"CDM"},{"code":"351","type":"RC"},{"code":"70496","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1527.48,"discounted_cash":763.74,"setting":"both","billing_class":"facility"}]},{"description":"CTA NECK WO/W","code_information":[{"code":"14075","type":"CDM"},{"code":"351","type":"RC"},{"code":"70498","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":3028.36,"discounted_cash":1514.18,"setting":"both","billing_class":"facility"}]},{"description":"CT THORAX W/O","code_information":[{"code":"14076","type":"CDM"},{"code":"352","type":"RC"},{"code":"71250","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1878.34,"discounted_cash":939.17,"setting":"both","billing_class":"facility"}]},{"description":"CT THORAX W","code_information":[{"code":"14077","type":"CDM"},{"code":"352","type":"RC"},{"code":"71260","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2277.26,"discounted_cash":1138.63,"setting":"both","billing_class":"facility"}]},{"description":"CT THORAX WW/O","code_information":[{"code":"14078","type":"CDM"},{"code":"352","type":"RC"},{"code":"71270","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2283.64,"discounted_cash":1141.82,"setting":"both","billing_class":"facility"}]},{"description":"CTA CHEST WO/W","code_information":[{"code":"14079","type":"CDM"},{"code":"352","type":"RC"},{"code":"71275","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2939.69,"discounted_cash":1469.85,"setting":"both","billing_class":"facility"}]},{"description":"CT C-SPINE WO/","code_information":[{"code":"14080","type":"CDM"},{"code":"352","type":"RC"},{"code":"72125","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2070.82,"discounted_cash":1035.41,"setting":"both","billing_class":"facility"}]},{"description":"CT C-SPINE W","code_information":[{"code":"14081","type":"CDM"},{"code":"352","type":"RC"},{"code":"72126","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1795.99,"discounted_cash":898.0,"setting":"both","billing_class":"facility"}]},{"description":"CT C-SPINE WO/W","code_information":[{"code":"14082","type":"CDM"},{"code":"352","type":"RC"},{"code":"72127","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2533.18,"discounted_cash":1266.59,"setting":"both","billing_class":"facility"}]},{"description":"CT T-SPINE W/O","code_information":[{"code":"14085","type":"CDM"},{"code":"352","type":"RC"},{"code":"72128","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.07,"discounted_cash":853.03,"setting":"both","billing_class":"facility"}]},{"description":"CT T-SPINE W","code_information":[{"code":"14088","type":"CDM"},{"code":"352","type":"RC"},{"code":"72129","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1889.73,"discounted_cash":944.87,"setting":"both","billing_class":"facility"}]},{"description":"CT T-SPINE WO/W","code_information":[{"code":"14089","type":"CDM"},{"code":"352","type":"RC"},{"code":"72130","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2532.14,"discounted_cash":1266.07,"setting":"both","billing_class":"facility"}]},{"description":"CT L-SPINE WO","code_information":[{"code":"14090","type":"CDM"},{"code":"352","type":"RC"},{"code":"72131","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2216.5,"discounted_cash":1108.25,"setting":"both","billing_class":"facility"}]},{"description":"CT L-SPINE W","code_information":[{"code":"14091","type":"CDM"},{"code":"352","type":"RC"},{"code":"72132","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1787.16,"discounted_cash":893.58,"setting":"both","billing_class":"facility"}]},{"description":"CT L-SPINE WO/W","code_information":[{"code":"14092","type":"CDM"},{"code":"352","type":"RC"},{"code":"72133","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2704.09,"discounted_cash":1352.05,"setting":"both","billing_class":"facility"}]},{"description":"CTA PELVIS WO/W","code_information":[{"code":"14093","type":"CDM"},{"code":"352","type":"RC"},{"code":"72191","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1561.65,"discounted_cash":780.83,"setting":"both","billing_class":"facility"}]},{"description":"CT PELVIS W/O","code_information":[{"code":"14094","type":"CDM"},{"code":"352","type":"RC"},{"code":"72192","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2003.68,"discounted_cash":1001.84,"setting":"both","billing_class":"facility"}]},{"description":"CT PELVIS W","code_information":[{"code":"14095","type":"CDM"},{"code":"352","type":"RC"},{"code":"72193","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1996.11,"discounted_cash":998.05,"setting":"both","billing_class":"facility"}]},{"description":"CT PELVIS WW/O","code_information":[{"code":"14096","type":"CDM"},{"code":"352","type":"RC"},{"code":"72194","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2644.58,"discounted_cash":1322.29,"setting":"both","billing_class":"facility"}]},{"description":"CT HEART CA SCORE","code_information":[{"code":"14097","type":"CDM"},{"code":"359","type":"RC"},{"code":"75571","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.46,"discounted_cash":51.73,"setting":"both","billing_class":"facility"}]},{"description":"CT ANGIO HRT W/3D","code_information":[{"code":"14098","type":"CDM"},{"code":"359","type":"RC"},{"code":"75574","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":4232.98,"discounted_cash":2116.49,"setting":"both","billing_class":"facility"}]},{"description":"CT UP EXT W/O  LT","code_information":[{"code":"14099","type":"CDM"},{"code":"352","type":"RC"},{"code":"73200","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1603.45,"discounted_cash":801.73,"setting":"both","billing_class":"facility"}]},{"description":"CT UP EXT W/O  RT","code_information":[{"code":"14100","type":"CDM"},{"code":"352","type":"RC"},{"code":"73200","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1603.45,"discounted_cash":801.73,"setting":"both","billing_class":"facility"}]},{"description":"CT UP EXT W LT","code_information":[{"code":"14101","type":"CDM"},{"code":"352","type":"RC"},{"code":"73201","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":955.0,"setting":"both","billing_class":"facility"}]},{"description":"CT UP EXT W  RT","code_information":[{"code":"14102","type":"CDM"},{"code":"352","type":"RC"},{"code":"73201","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":955.0,"setting":"both","billing_class":"facility"}]},{"description":"CT UP EXT W/WO  LT","code_information":[{"code":"14103","type":"CDM"},{"code":"352","type":"RC"},{"code":"73202","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1968.26,"discounted_cash":984.13,"setting":"both","billing_class":"facility"}]},{"description":"CT UP EXT W/WO  RT","code_information":[{"code":"14104","type":"CDM"},{"code":"352","type":"RC"},{"code":"73202","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1868.2,"discounted_cash":934.1,"setting":"both","billing_class":"facility"}]},{"description":"CTA UP EXT WO/W","code_information":[{"code":"14105","type":"CDM"},{"code":"352","type":"RC"},{"code":"73206","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1562.95,"discounted_cash":781.48,"setting":"both","billing_class":"facility"}]},{"description":"CT LOW EXT W/O LT","code_information":[{"code":"14106","type":"CDM"},{"code":"352","type":"RC"},{"code":"73700","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.14,"discounted_cash":960.07,"setting":"both","billing_class":"facility"}]},{"description":"CT LOW EXT W/O RT","code_information":[{"code":"14107","type":"CDM"},{"code":"352","type":"RC"},{"code":"73700","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.14,"discounted_cash":960.07,"setting":"both","billing_class":"facility"}]},{"description":"CT LOW EXT W  LT","code_information":[{"code":"14108","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1954.31,"discounted_cash":977.15,"setting":"both","billing_class":"facility"}]},{"description":"CT LOW EXT W  RT","code_information":[{"code":"14109","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2058.18,"discounted_cash":1029.09,"setting":"both","billing_class":"facility"}]},{"description":"CT LOW EXT WW/O  LT","code_information":[{"code":"14110","type":"CDM"},{"code":"352","type":"RC"},{"code":"73702","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1592.06,"discounted_cash":796.03,"setting":"both","billing_class":"facility"}]},{"description":"CT LOW EXT WW/O  RT","code_information":[{"code":"14111","type":"CDM"},{"code":"352","type":"RC"},{"code":"73702","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1592.06,"discounted_cash":796.03,"setting":"both","billing_class":"facility"}]},{"description":"CTA LOW EXT WO/W","code_information":[{"code":"14112","type":"CDM"},{"code":"352","type":"RC"},{"code":"73706","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1562.95,"discounted_cash":781.48,"setting":"both","billing_class":"facility"}]},{"description":"CT ABDOMEN W/O","code_information":[{"code":"14113","type":"CDM"},{"code":"352","type":"RC"},{"code":"74150","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1830.21,"discounted_cash":915.11,"setting":"both","billing_class":"facility"}]},{"description":"CT ABDOMEN W","code_information":[{"code":"14116","type":"CDM"},{"code":"352","type":"RC"},{"code":"74160","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.92,"discounted_cash":1075.96,"setting":"both","billing_class":"facility"}]},{"description":"CT ABDOMEN WW/O","code_information":[{"code":"14119","type":"CDM"},{"code":"352","type":"RC"},{"code":"74170","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2471.06,"discounted_cash":1235.53,"setting":"both","billing_class":"facility"}]},{"description":"CTA ABD WO/W","code_information":[{"code":"14120","type":"CDM"},{"code":"352","type":"RC"},{"code":"74175","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2605.29,"discounted_cash":1302.64,"setting":"both","billing_class":"facility"}]},{"description":"CT ABD/PELVIS W/O C","code_information":[{"code":"14121","type":"CDM"},{"code":"352","type":"RC"},{"code":"74176","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2350.73,"discounted_cash":1175.37,"setting":"both","billing_class":"facility"}]},{"description":"CT ABD/PELVIS W/CONT","code_information":[{"code":"14122","type":"CDM"},{"code":"352","type":"RC"},{"code":"74177","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2753.52,"discounted_cash":1376.76,"setting":"both","billing_class":"facility"}]},{"description":"CT ABD/PELVIS W/WO/C","code_information":[{"code":"14123","type":"CDM"},{"code":"352","type":"RC"},{"code":"74178","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":3272.84,"discounted_cash":1636.42,"setting":"both","billing_class":"facility"}]},{"description":"CTA ABD/PELVIS W/WO","code_information":[{"code":"14125","type":"CDM"},{"code":"352","type":"RC"},{"code":"74174","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":3856.73,"discounted_cash":1928.37,"setting":"both","billing_class":"facility"}]},{"description":"CT GUIDE PERC DRN","code_information":[{"code":"14126","type":"CDM"},{"code":"350","type":"RC"},{"code":"75989","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1312.31,"discounted_cash":656.15,"setting":"both","billing_class":"facility"}]},{"description":"CT NDL PLC GUIDE","code_information":[{"code":"14131","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1937.85,"discounted_cash":968.92,"setting":"both","billing_class":"facility"}]},{"description":"CT LOW DOSE LUNG SCR","code_information":[{"code":"14132","type":"CDM"},{"code":"352","type":"RC"},{"code":"71271","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":448.36,"discounted_cash":224.18,"setting":"both","billing_class":"facility"}]},{"description":"CTA ABD W/RUNOFF","code_information":[{"code":"14148","type":"CDM"},{"code":"352","type":"RC"},{"code":"75635","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1656.69,"discounted_cash":828.35,"setting":"both","billing_class":"facility"}]},{"description":"SIMULATION SIMPLE","code_information":[{"code":"14149","type":"CDM"},{"code":"333","type":"RC"},{"code":"77280","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":470.15,"discounted_cash":235.07,"setting":"both","billing_class":"facility"}]},{"description":"SIMULATION INTERMED","code_information":[{"code":"14150","type":"CDM"},{"code":"333","type":"RC"},{"code":"77285","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.87,"discounted_cash":560.43,"setting":"both","billing_class":"facility"}]},{"description":"SIMULATION COMPLEX","code_information":[{"code":"14151","type":"CDM"},{"code":"333","type":"RC"},{"code":"77290","type":"CPT"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.87,"discounted_cash":560.43,"setting":"both","billing_class":"facility"}]},{"description":"CREATININE POC","code_information":[{"code":"14156","type":"CDM"},{"code":"300","type":"RC"},{"code":"82565","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.1,"discounted_cash":14.55,"setting":"both","billing_class":"facility"}]},{"description":"G1001 EVICORE","code_information":[{"code":"14158","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1001","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1002 MEDCURRENT","code_information":[{"code":"14159","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1002","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1003 MEDICALIS","code_information":[{"code":"14160","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1003","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1004 NTL DECISION","code_information":[{"code":"14161","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1004","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1007 AIM SPECIALTY","code_information":[{"code":"14162","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1007","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1008 CRANBERRY PEAK","code_information":[{"code":"14163","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1008","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1010 STANSON","code_information":[{"code":"14165","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1010","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1011 QLFD TOOL OTHR","code_information":[{"code":"14166","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1011","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1012 AGILEMD","code_information":[{"code":"14167","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1012","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1013 EVIDENCECARE","code_information":[{"code":"14168","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1013","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1014 INVENIQA SEMAN","code_information":[{"code":"14169","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1014","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1015 RELIANT MED GR","code_information":[{"code":"14170","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1015","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1016 SPEED OF CARE","code_information":[{"code":"14171","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1016","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1017 HEALTHHELP","code_information":[{"code":"14172","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1017","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1018 INFINX CDSM","code_information":[{"code":"14173","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1018","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1019 LOGICNETS","code_information":[{"code":"14174","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1019","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1020 CURBSIDE","code_information":[{"code":"14175","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1020","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1021 EHEALTHLINE","code_information":[{"code":"14176","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1021","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1022 INTERMOUNTAIN","code_information":[{"code":"14177","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1022","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1023 PERSIVIA","code_information":[{"code":"14178","type":"CDM"},{"code":"359","type":"RC"},{"code":"G1023","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"LOCM 300-399MG I 1ML","code_information":[{"code":"14182","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"770","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.34,"setting":"both","billing_class":"facility"}]},{"description":"ACTIGRAPHY TESTING","code_information":[{"code":"14186","type":"CDM"},{"code":"920","type":"RC"},{"code":"95803","type":"CPT"},{"code":"737","type":"LOCAL"}],"standard_charges":[{"gross_charge":229.22,"discounted_cash":114.61,"setting":"both","billing_class":"facility"}]},{"description":"POLYSOMNOGRAPHY 4 +","code_information":[{"code":"14187","type":"CDM"},{"code":"740","type":"RC"},{"code":"95810","type":"CPT"},{"code":"737","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.69,"discounted_cash":2557.84,"setting":"both","billing_class":"facility"}]},{"description":"POLYSOMNOGR 4+/CPAP","code_information":[{"code":"14188","type":"CDM"},{"code":"740","type":"RC"},{"code":"95811","type":"CPT"},{"code":"737","type":"LOCAL"}],"standard_charges":[{"gross_charge":5719.86,"discounted_cash":2859.93,"setting":"both","billing_class":"facility"}]},{"description":"MULT SLEEP LATENCY T","code_information":[{"code":"14189","type":"CDM"},{"code":"740","type":"RC"},{"code":"95805","type":"CPT"},{"code":"737","type":"LOCAL"}],"standard_charges":[{"gross_charge":4053.03,"discounted_cash":2026.52,"setting":"both","billing_class":"facility"}]},{"description":"HOME SLEEP STUDY","code_information":[{"code":"14194","type":"CDM"},{"code":"920","type":"RC"},{"code":"G0399","type":"HCPCS"},{"code":"737","type":"LOCAL"}],"standard_charges":[{"gross_charge":728.31,"discounted_cash":364.15,"setting":"both","billing_class":"facility"}]},{"description":"PULSE OX OVERNIGHT","code_information":[{"code":"14195","type":"CDM"},{"code":"460","type":"RC"},{"code":"94762","type":"CPT"},{"code":"737","type":"LOCAL"}],"standard_charges":[{"gross_charge":330.53,"discounted_cash":165.26,"setting":"both","billing_class":"facility"}]},{"description":"INJ SINOGRAM","code_information":[{"code":"14204","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":635.78,"discounted_cash":317.89,"setting":"both","billing_class":"facility"}]},{"description":"ASPIR/INJ MAJOR JOIN","code_information":[{"code":"14207","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":506.62,"discounted_cash":253.31,"setting":"both","billing_class":"facility"}]},{"description":"INJ SHLDER ARTHRO RT","code_information":[{"code":"14209","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.94,"discounted_cash":75.97,"setting":"both","billing_class":"facility"}]},{"description":"INJ SHLDER ARTHRO LT","code_information":[{"code":"14210","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.94,"discounted_cash":75.97,"setting":"both","billing_class":"facility"}]},{"description":"INJ NEW T-TUBE CHOLE","code_information":[{"code":"14238","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":6039.06,"discounted_cash":3019.53,"setting":"both","billing_class":"facility"}]},{"description":"INJ EX T-TUBE CHOLE","code_information":[{"code":"14240","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":3799.72,"discounted_cash":1899.86,"setting":"both","billing_class":"facility"}]},{"description":"INJ CONTRAST GI TUBE","code_information":[{"code":"14250","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":328.03,"discounted_cash":164.01,"setting":"both","billing_class":"facility"}]},{"description":"INJ CYSTOGRAM/VCU","code_information":[{"code":"14256","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.36,"discounted_cash":559.18,"setting":"both","billing_class":"facility"}]},{"description":"INJ HYSTEROSALPING","code_information":[{"code":"14258","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":168.4,"discounted_cash":84.2,"setting":"both","billing_class":"facility"}]},{"description":"SPINAL FLUID TAP DIA","code_information":[{"code":"14261","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":1605.33,"discounted_cash":802.66,"setting":"both","billing_class":"facility"}]},{"description":"EYE FOR FOREIGN BODY","code_information":[{"code":"14273","type":"CDM"},{"code":"320","type":"RC"},{"code":"70030","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":208.95,"discounted_cash":104.47,"setting":"both","billing_class":"facility"}]},{"description":"MANDIBLE < 4 VWS","code_information":[{"code":"14274","type":"CDM"},{"code":"320","type":"RC"},{"code":"70100","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":252.05,"discounted_cash":126.03,"setting":"both","billing_class":"facility"}]},{"description":"MANDIBLE COMP MN 4 V","code_information":[{"code":"14275","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":353.37,"discounted_cash":176.69,"setting":"both","billing_class":"facility"}]},{"description":"MASTOIDS COMP MN 3VW","code_information":[{"code":"14277","type":"CDM"},{"code":"320","type":"RC"},{"code":"70130","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"FACIAL BONES COMP","code_information":[{"code":"14280","type":"CDM"},{"code":"320","type":"RC"},{"code":"70150","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.99,"discounted_cash":152.0,"setting":"both","billing_class":"facility"}]},{"description":"NASAL BONES COMP","code_information":[{"code":"14282","type":"CDM"},{"code":"320","type":"RC"},{"code":"70160","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"OPTIC FORAMNA","code_information":[{"code":"14284","type":"CDM"},{"code":"320","type":"RC"},{"code":"70190","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":363.5,"discounted_cash":181.75,"setting":"both","billing_class":"facility"}]},{"description":"ORBITS COMP MIN 4","code_information":[{"code":"14285","type":"CDM"},{"code":"320","type":"RC"},{"code":"70200","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":344.48,"discounted_cash":172.24,"setting":"both","billing_class":"facility"}]},{"description":"SINUS 1 0R 2 VIEWS","code_information":[{"code":"14286","type":"CDM"},{"code":"320","type":"RC"},{"code":"70210","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":272.27,"discounted_cash":136.13,"setting":"both","billing_class":"facility"}]},{"description":"SINUS PARA COMPLETE","code_information":[{"code":"14287","type":"CDM"},{"code":"320","type":"RC"},{"code":"70220","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":433.15,"discounted_cash":216.57,"setting":"both","billing_class":"facility"}]},{"description":"SKULL < 4VWS","code_information":[{"code":"14289","type":"CDM"},{"code":"320","type":"RC"},{"code":"70250","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"SKULL COMP","code_information":[{"code":"14290","type":"CDM"},{"code":"320","type":"RC"},{"code":"70260","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"TMJ O/C UNIL LT","code_information":[{"code":"14291","type":"CDM"},{"code":"320","type":"RC"},{"code":"70328","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":347.04,"discounted_cash":173.52,"setting":"both","billing_class":"facility"}]},{"description":"TMJ O/C UNIL RT","code_information":[{"code":"14292","type":"CDM"},{"code":"320","type":"RC"},{"code":"70328","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":347.04,"discounted_cash":173.52,"setting":"both","billing_class":"facility"}]},{"description":"TMJ BILATERAL","code_information":[{"code":"14293","type":"CDM"},{"code":"320","type":"RC"},{"code":"70330","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":577.52,"discounted_cash":288.76,"setting":"both","billing_class":"facility"}]},{"description":"NECK SOFT TISSUE","code_information":[{"code":"14295","type":"CDM"},{"code":"320","type":"RC"},{"code":"70360","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":310.31,"discounted_cash":155.16,"setting":"both","billing_class":"facility"}]},{"description":"CHEST 2 VWSW/FLUORO","code_information":[{"code":"14310","type":"CDM"},{"code":"324","type":"RC"},{"code":"71046","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":436.97,"discounted_cash":218.49,"setting":"both","billing_class":"facility"}]},{"description":"RIBS UNIL 2 VWS RT","code_information":[{"code":"14318","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.11,"discounted_cash":147.56,"setting":"both","billing_class":"facility"}]},{"description":"RIBS UNIL 2VWS LT","code_information":[{"code":"14319","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.11,"discounted_cash":147.56,"setting":"both","billing_class":"facility"}]},{"description":"RIB W/CHST 3V UNI RT","code_information":[{"code":"14320","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":335.65,"discounted_cash":167.82,"setting":"both","billing_class":"facility"}]},{"description":"RIB W/CHST 3V UNI LT","code_information":[{"code":"14321","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":335.65,"discounted_cash":167.82,"setting":"both","billing_class":"facility"}]},{"description":"RIBS W/CHST BIL 4VWS","code_information":[{"code":"14323","type":"CDM"},{"code":"320","type":"RC"},{"code":"71111","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.62,"discounted_cash":177.31,"setting":"both","billing_class":"facility"}]},{"description":"STERNUM 2/>VWS","code_information":[{"code":"14324","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"STERNOCLAVIC JT 3/>V","code_information":[{"code":"14325","type":"CDM"},{"code":"320","type":"RC"},{"code":"71130","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":230.53,"discounted_cash":115.27,"setting":"both","billing_class":"facility"}]},{"description":"CERV SPINE 1 VW","code_information":[{"code":"14329","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":316.69,"discounted_cash":158.34,"setting":"both","billing_class":"facility"}]},{"description":"LUMBAR SPINE 1 VIEW","code_information":[{"code":"14330","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.49,"discounted_cash":124.75,"setting":"both","billing_class":"facility"}]},{"description":"CERV SPINE 3VW >LESS","code_information":[{"code":"14331","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":411.63,"discounted_cash":205.81,"setting":"both","billing_class":"facility"}]},{"description":"C SPINE 4 OR 5 VIEWS","code_information":[{"code":"14332","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":474.95,"discounted_cash":237.47,"setting":"both","billing_class":"facility"}]},{"description":"C SPINE 6 OR >VIEWS","code_information":[{"code":"14333","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":620.63,"discounted_cash":310.31,"setting":"both","billing_class":"facility"}]},{"description":"SCOLIOSIS COMPLETE","code_information":[{"code":"14335","type":"CDM"},{"code":"320","type":"RC"},{"code":"72084","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":398.98,"discounted_cash":199.49,"setting":"both","billing_class":"facility"}]},{"description":"SCOLIOSIS EVAL 2-3 V","code_information":[{"code":"14336","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"THORACIC SPINE 2 VW","code_information":[{"code":"14337","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"THORACIC SPINE  3 VW","code_information":[{"code":"14338","type":"CDM"},{"code":"320","type":"RC"},{"code":"72072","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":500.29,"discounted_cash":250.15,"setting":"both","billing_class":"facility"}]},{"description":"LS SPINE 2 OR 3 V","code_information":[{"code":"14342","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"LS SPINE 4VW >","code_information":[{"code":"14343","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":454.68,"discounted_cash":227.34,"setting":"both","billing_class":"facility"}]},{"description":"LS SPINE COMP W/BEND","code_information":[{"code":"14345","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":618.07,"discounted_cash":309.04,"setting":"both","billing_class":"facility"}]},{"description":"PELVIS AP ONLY","code_information":[{"code":"14347","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":286.23,"discounted_cash":143.12,"setting":"both","billing_class":"facility"}]},{"description":"PELVIS COMP > 3","code_information":[{"code":"14349","type":"CDM"},{"code":"320","type":"RC"},{"code":"72190","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.25,"discounted_cash":105.13,"setting":"both","billing_class":"facility"}]},{"description":"SI JOINTS < 3","code_information":[{"code":"14350","type":"CDM"},{"code":"320","type":"RC"},{"code":"72200","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"SI JOINTS > 3","code_information":[{"code":"14351","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"SACRUM & COCCYX","code_information":[{"code":"14352","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.61,"discounted_cash":120.31,"setting":"both","billing_class":"facility"}]},{"description":"CLAVICLE COMP LT","code_information":[{"code":"14361","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.96,"discounted_cash":189.98,"setting":"both","billing_class":"facility"}]},{"description":"CLAVICLE COMP RT","code_information":[{"code":"14362","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.96,"discounted_cash":189.98,"setting":"both","billing_class":"facility"}]},{"description":"SCAPULA COMP LT","code_information":[{"code":"14363","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"SCAPULA COMP RT","code_information":[{"code":"14364","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"SHOULDER 1VW LT","code_information":[{"code":"14365","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.62,"discounted_cash":177.31,"setting":"both","billing_class":"facility"}]},{"description":"SHOULDER 1VW RT","code_information":[{"code":"14366","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.62,"discounted_cash":177.31,"setting":"both","billing_class":"facility"}]},{"description":"SHOULDER COMP LT","code_information":[{"code":"14367","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":474.95,"discounted_cash":237.47,"setting":"both","billing_class":"facility"}]},{"description":"SHOULDER COMP RT","code_information":[{"code":"14368","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":474.95,"discounted_cash":237.47,"setting":"both","billing_class":"facility"}]},{"description":"ARTHROGRAM SHOULD RT","code_information":[{"code":"14369","type":"CDM"},{"code":"320","type":"RC"},{"code":"73040","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":858.36,"discounted_cash":429.18,"setting":"both","billing_class":"facility"}]},{"description":"ARTHROGRAM SHOULD LT","code_information":[{"code":"14370","type":"CDM"},{"code":"320","type":"RC"},{"code":"73040","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":858.36,"discounted_cash":429.18,"setting":"both","billing_class":"facility"}]},{"description":"ACROMIO CLAV JNTS","code_information":[{"code":"14371","type":"CDM"},{"code":"320","type":"RC"},{"code":"73050","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":316.69,"discounted_cash":158.34,"setting":"both","billing_class":"facility"}]},{"description":"HUMERUS 2VW LT","code_information":[{"code":"14373","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":273.58,"discounted_cash":136.79,"setting":"both","billing_class":"facility"}]},{"description":"HUMERUS 2VW RT","code_information":[{"code":"14374","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":273.58,"discounted_cash":136.79,"setting":"both","billing_class":"facility"}]},{"description":"ELBOW 2VW LT","code_information":[{"code":"14375","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"ELBOW 2VW RT","code_information":[{"code":"14376","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"ELBOW COMP 3VW LT","code_information":[{"code":"14377","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.96,"discounted_cash":189.98,"setting":"both","billing_class":"facility"}]},{"description":"ELBOW COMP 3VW RT","code_information":[{"code":"14378","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.96,"discounted_cash":189.98,"setting":"both","billing_class":"facility"}]},{"description":"FOREARM 2VW LT","code_information":[{"code":"14380","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":328.03,"discounted_cash":164.01,"setting":"both","billing_class":"facility"}]},{"description":"FOREARM 2VW RT","code_information":[{"code":"14381","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":328.03,"discounted_cash":164.01,"setting":"both","billing_class":"facility"}]},{"description":"UP EXT INFANT 2V RT","code_information":[{"code":"14382","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"UP EXT INFANT 2V LT","code_information":[{"code":"14383","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":297.62,"discounted_cash":148.81,"setting":"both","billing_class":"facility"}]},{"description":"WRIST 2VW LT","code_information":[{"code":"14384","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":279.9,"discounted_cash":139.95,"setting":"both","billing_class":"facility"}]},{"description":"WRIST 2VW RT","code_information":[{"code":"14385","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":279.9,"discounted_cash":139.95,"setting":"both","billing_class":"facility"}]},{"description":"WRIST COMP >3VW LT","code_information":[{"code":"14386","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":338.16,"discounted_cash":169.08,"setting":"both","billing_class":"facility"}]},{"description":"WRIST COMP >3VW RT","code_information":[{"code":"14387","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":338.16,"discounted_cash":169.08,"setting":"both","billing_class":"facility"}]},{"description":"HAND 2 VW LT","code_information":[{"code":"14389","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":362.25,"discounted_cash":181.13,"setting":"both","billing_class":"facility"}]},{"description":"HAND 2 VW RT","code_information":[{"code":"14390","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":362.25,"discounted_cash":181.13,"setting":"both","billing_class":"facility"}]},{"description":"HAND 2 VW BL","code_information":[{"code":"14391","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":362.25,"discounted_cash":181.13,"setting":"both","billing_class":"facility"}]},{"description":"HAND 3 VW LT","code_information":[{"code":"14392","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":338.16,"discounted_cash":169.08,"setting":"both","billing_class":"facility"}]},{"description":"HAND 3 VW RT","code_information":[{"code":"14393","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":338.16,"discounted_cash":169.08,"setting":"both","billing_class":"facility"}]},{"description":"FINGER 2VW LT","code_information":[{"code":"14394","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"FINGER 2VW RT","code_information":[{"code":"14395","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"HIP 2-3 LT","code_information":[{"code":"14398","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"HIP 2-3 RT","code_information":[{"code":"14399","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"HIP 1 VIEW LT","code_information":[{"code":"14400","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"HIP 1 VIEW RT","code_information":[{"code":"14401","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"HIP 4+ LT","code_information":[{"code":"14404","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"HIP 4+ RT","code_information":[{"code":"14405","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"BILAT HIPS W/PEL 2VW","code_information":[{"code":"14407","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":263.44,"discounted_cash":131.72,"setting":"both","billing_class":"facility"}]},{"description":"BILAT HIPS W/ PEL3-4","code_information":[{"code":"14408","type":"CDM"},{"code":"320","type":"RC"},{"code":"73522","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":263.44,"discounted_cash":131.72,"setting":"both","billing_class":"facility"}]},{"description":"BILAT HIPS W/ PEL 5+","code_information":[{"code":"14409","type":"CDM"},{"code":"320","type":"RC"},{"code":"73523","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":474.95,"discounted_cash":237.47,"setting":"both","billing_class":"facility"}]},{"description":"ARTHROGRAM HIP LT","code_information":[{"code":"14411","type":"CDM"},{"code":"320","type":"RC"},{"code":"73525","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":1076.56,"discounted_cash":538.28,"setting":"both","billing_class":"facility"}]},{"description":"HIP PINNING  1 VW RT","code_information":[{"code":"14412","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"HIP PINNING 1 VW LT","code_information":[{"code":"14413","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"HIP PINNING 2-3 RT","code_information":[{"code":"14414","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"HIP PINNING 2-3 LT","code_information":[{"code":"14415","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"HIP PINNING 4+ RT","code_information":[{"code":"14416","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"HIP PINNING 4+ LT","code_information":[{"code":"14417","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"FEMUR 1 VIEW LT","code_information":[{"code":"14423","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":189.98,"discounted_cash":94.99,"setting":"both","billing_class":"facility"}]},{"description":"FEMUR 1 VIEW RT","code_information":[{"code":"14424","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":189.98,"discounted_cash":94.99,"setting":"both","billing_class":"facility"}]},{"description":"FEMUR 2+ VIEW LT","code_information":[{"code":"14425","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"FEMUR 2+ VIEW RT","code_information":[{"code":"14426","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"KNEE 1-2VW LT","code_information":[{"code":"14427","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":469.88,"discounted_cash":234.94,"setting":"both","billing_class":"facility"}]},{"description":"KNEE 1-2VW RT","code_information":[{"code":"14428","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":469.88,"discounted_cash":234.94,"setting":"both","billing_class":"facility"}]},{"description":"KNEE 3V LT","code_information":[{"code":"14430","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":716.87,"discounted_cash":358.44,"setting":"both","billing_class":"facility"}]},{"description":"KNEE 3V RT","code_information":[{"code":"14431","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":716.87,"discounted_cash":358.44,"setting":"both","billing_class":"facility"}]},{"description":"KNEE COMP > 4 LT","code_information":[{"code":"14433","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":616.81,"discounted_cash":308.4,"setting":"both","billing_class":"facility"}]},{"description":"KNEE COMP > 4 RT","code_information":[{"code":"14434","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":616.81,"discounted_cash":308.4,"setting":"both","billing_class":"facility"}]},{"description":"KNEE STANDING  BILAT","code_information":[{"code":"14435","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":366.06,"discounted_cash":183.03,"setting":"both","billing_class":"facility"}]},{"description":"TIBIA FIBULA 2V LT","code_information":[{"code":"14437","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":357.13,"discounted_cash":178.56,"setting":"both","billing_class":"facility"}]},{"description":"TIBIA FIBULA 2V RT","code_information":[{"code":"14438","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":357.13,"discounted_cash":178.56,"setting":"both","billing_class":"facility"}]},{"description":"LOW EXT INFNT >2V RT","code_information":[{"code":"14439","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"LOW EXT INFNT >2V LT","code_information":[{"code":"14440","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"ANKLE 2V LT","code_information":[{"code":"14441","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":284.97,"discounted_cash":142.49,"setting":"both","billing_class":"facility"}]},{"description":"ANKLE 2V RT","code_information":[{"code":"14442","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":284.97,"discounted_cash":142.49,"setting":"both","billing_class":"facility"}]},{"description":"ANKLE COMP >3V LT","code_information":[{"code":"14443","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":360.94,"discounted_cash":180.47,"setting":"both","billing_class":"facility"}]},{"description":"ANKLE COMP >3V RT","code_information":[{"code":"14444","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":360.94,"discounted_cash":180.47,"setting":"both","billing_class":"facility"}]},{"description":"FOOT 2V LT","code_information":[{"code":"14446","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":305.24,"discounted_cash":152.62,"setting":"both","billing_class":"facility"}]},{"description":"FOOT 2V RT","code_information":[{"code":"14447","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":305.24,"discounted_cash":152.62,"setting":"both","billing_class":"facility"}]},{"description":"FOOT 2V BL","code_information":[{"code":"14448","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":305.24,"discounted_cash":152.62,"setting":"both","billing_class":"facility"}]},{"description":"FOOT COMP >3 LT","code_information":[{"code":"14449","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":355.87,"discounted_cash":177.94,"setting":"both","billing_class":"facility"}]},{"description":"FOOT COMP >3 RT","code_information":[{"code":"14450","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":355.87,"discounted_cash":177.94,"setting":"both","billing_class":"facility"}]},{"description":"FOOT COMP 3V BL","code_information":[{"code":"14451","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":355.87,"discounted_cash":177.94,"setting":"both","billing_class":"facility"}]},{"description":"CALCANEUS 2VW LT","code_information":[{"code":"14452","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.25,"discounted_cash":202.63,"setting":"both","billing_class":"facility"}]},{"description":"CALCANEUS 2VW RT","code_information":[{"code":"14453","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.25,"discounted_cash":202.63,"setting":"both","billing_class":"facility"}]},{"description":"TOE (S)  >2 LT","code_information":[{"code":"14454","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"TOE (S)  >2 RT","code_information":[{"code":"14455","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"ABD COMP ACUTE SERIE","code_information":[{"code":"14461","type":"CDM"},{"code":"320","type":"RC"},{"code":"74022","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.96,"discounted_cash":189.98,"setting":"both","billing_class":"facility"}]},{"description":"ESOPHAG/BAR SWALLOW","code_information":[{"code":"14464","type":"CDM"},{"code":"320","type":"RC"},{"code":"74220","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":645.97,"discounted_cash":322.99,"setting":"both","billing_class":"facility"}]},{"description":"SWALLOW FUNC W/VIDEO","code_information":[{"code":"14465","type":"CDM"},{"code":"320","type":"RC"},{"code":"74230","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"UGI W/WO DLAY WO KUB","code_information":[{"code":"14467","type":"CDM"},{"code":"320","type":"RC"},{"code":"74240","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":1090.51,"discounted_cash":545.25,"setting":"both","billing_class":"facility"}]},{"description":"UGI W/WO DELAY KUB","code_information":[{"code":"14468","type":"CDM"},{"code":"320","type":"RC"},{"code":"74240","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.62,"discounted_cash":692.81,"setting":"both","billing_class":"facility"}]},{"description":"UGI W/SMALL BOWEL","code_information":[{"code":"14469","type":"CDM"},{"code":"320","type":"RC"},{"code":"74240","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":1670.59,"discounted_cash":835.29,"setting":"both","billing_class":"facility"}]},{"description":"UGI AIR/CONT WO KUB","code_information":[{"code":"14470","type":"CDM"},{"code":"320","type":"RC"},{"code":"74246","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":1490.74,"discounted_cash":745.37,"setting":"both","billing_class":"facility"}]},{"description":"XR CERVICL ESOPHAGUS","code_information":[{"code":"14471","type":"CDM"},{"code":"320","type":"RC"},{"code":"74210","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"UGI W/AIR CONT W/KUB","code_information":[{"code":"14472","type":"CDM"},{"code":"320","type":"RC"},{"code":"74246","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":766.61,"discounted_cash":383.31,"setting":"both","billing_class":"facility"}]},{"description":"UGI AIR CNST SM BOW","code_information":[{"code":"14473","type":"CDM"},{"code":"320","type":"RC"},{"code":"74246","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":2289.96,"discounted_cash":1144.98,"setting":"both","billing_class":"facility"}]},{"description":"SMALL BOWEL SERIES","code_information":[{"code":"14474","type":"CDM"},{"code":"320","type":"RC"},{"code":"74250","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.91,"discounted_cash":370.45,"setting":"both","billing_class":"facility"}]},{"description":"BAR ENEMA W/WO KUB","code_information":[{"code":"14477","type":"CDM"},{"code":"320","type":"RC"},{"code":"74270","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":1136.07,"discounted_cash":568.03,"setting":"both","billing_class":"facility"}]},{"description":"BAR ENEMA AIR CNRST","code_information":[{"code":"14478","type":"CDM"},{"code":"320","type":"RC"},{"code":"74280","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":1051.27,"discounted_cash":525.63,"setting":"both","billing_class":"facility"}]},{"description":"CHOLANGIO INTRAOP","code_information":[{"code":"14482","type":"CDM"},{"code":"320","type":"RC"},{"code":"74300","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":664.93,"discounted_cash":332.46,"setting":"both","billing_class":"facility"}]},{"description":"IVP","code_information":[{"code":"14494","type":"CDM"},{"code":"320","type":"RC"},{"code":"74400","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":858.36,"discounted_cash":429.18,"setting":"both","billing_class":"facility"}]},{"description":"IVP INFUSION W/TOMO","code_information":[{"code":"14496","type":"CDM"},{"code":"320","type":"RC"},{"code":"74415","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":858.36,"discounted_cash":429.18,"setting":"both","billing_class":"facility"}]},{"description":"UROGRAM RETROGRADE","code_information":[{"code":"14497","type":"CDM"},{"code":"320","type":"RC"},{"code":"74420","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":775.13,"discounted_cash":387.56,"setting":"both","billing_class":"facility"}]},{"description":"CYSTOGRAM MN 3 VWS","code_information":[{"code":"14499","type":"CDM"},{"code":"320","type":"RC"},{"code":"74430","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":858.36,"discounted_cash":429.18,"setting":"both","billing_class":"facility"}]},{"description":"URETHROCYST RETRO","code_information":[{"code":"14501","type":"CDM"},{"code":"320","type":"RC"},{"code":"74450","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":624.39,"discounted_cash":312.19,"setting":"both","billing_class":"facility"}]},{"description":"URETHROCYST VOID","code_information":[{"code":"14502","type":"CDM"},{"code":"320","type":"RC"},{"code":"74455","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":704.23,"discounted_cash":352.12,"setting":"both","billing_class":"facility"}]},{"description":"HYSTEROSALPINGOGRM","code_information":[{"code":"14504","type":"CDM"},{"code":"320","type":"RC"},{"code":"74740","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":858.36,"discounted_cash":429.18,"setting":"both","billing_class":"facility"}]},{"description":"FLUORO GUIDE CVAD","code_information":[{"code":"14520","type":"CDM"},{"code":"320","type":"RC"},{"code":"77001","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"FLUORO SEP PROC TO 1","code_information":[{"code":"14521","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":606.67,"discounted_cash":303.33,"setting":"both","billing_class":"facility"}]},{"description":"FLUORO NDL PLACE","code_information":[{"code":"14523","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":861.29,"discounted_cash":430.64,"setting":"both","billing_class":"facility"}]},{"description":"FLUORO TX/DX INJ","code_information":[{"code":"14524","type":"CDM"},{"code":"320","type":"RC"},{"code":"77003","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":576.27,"discounted_cash":288.13,"setting":"both","billing_class":"facility"}]},{"description":"NOSE TO RECTUM FB CH","code_information":[{"code":"14525","type":"CDM"},{"code":"320","type":"RC"},{"code":"76010","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":485.09,"discounted_cash":242.54,"setting":"both","billing_class":"facility"}]},{"description":"BONE AGE STUDY","code_information":[{"code":"14526","type":"CDM"},{"code":"320","type":"RC"},{"code":"77072","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":316.69,"discounted_cash":158.34,"setting":"both","billing_class":"facility"}]},{"description":"BONE LENGTH STUDY","code_information":[{"code":"14527","type":"CDM"},{"code":"320","type":"RC"},{"code":"77073","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"BONE SURVEY LTD","code_information":[{"code":"14528","type":"CDM"},{"code":"320","type":"RC"},{"code":"77074","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"BONE SURVEY COMP","code_information":[{"code":"14529","type":"CDM"},{"code":"320","type":"RC"},{"code":"77075","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"BONE SURVEY INFANT","code_information":[{"code":"14530","type":"CDM"},{"code":"320","type":"RC"},{"code":"77076","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"ABSCESS FIST SINUS S","code_information":[{"code":"14531","type":"CDM"},{"code":"320","type":"RC"},{"code":"76080","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":949.96,"discounted_cash":474.98,"setting":"both","billing_class":"facility"}]},{"description":"XR HIP ARTHROGRAM RT","code_information":[{"code":"14541","type":"CDM"},{"code":"320","type":"RC"},{"code":"73525","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":1076.56,"discounted_cash":538.28,"setting":"both","billing_class":"facility"}]},{"description":"DXA BN DENSITY AXIAL","code_information":[{"code":"14555","type":"CDM"},{"code":"320","type":"RC"},{"code":"77085","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"DXA BN DENSITY WO VF","code_information":[{"code":"14557","type":"CDM"},{"code":"320","type":"RC"},{"code":"77080","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"XR FISTULAGRAM","code_information":[{"code":"14558","type":"CDM"},{"code":"320","type":"RC"},{"code":"76080","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":1761.14,"discounted_cash":880.57,"setting":"both","billing_class":"facility"}]},{"description":"XR XM ESOPHAGUS 2CNT","code_information":[{"code":"14559","type":"CDM"},{"code":"320","type":"RC"},{"code":"74221","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":727.06,"discounted_cash":363.53,"setting":"both","billing_class":"facility"}]},{"description":"XRAY SMALL INTEST","code_information":[{"code":"14560","type":"CDM"},{"code":"320","type":"RC"},{"code":"74248","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":189.98,"discounted_cash":94.99,"setting":"both","billing_class":"facility"}]},{"description":"INJ W/FL EVAL CVAD","code_information":[{"code":"14574","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":951.21,"discounted_cash":475.61,"setting":"both","billing_class":"facility"}]},{"description":"G1001 EVICORE","code_information":[{"code":"14577","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1001","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1002 MEDCURRENT","code_information":[{"code":"14578","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1002","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1003 MEDICALIS","code_information":[{"code":"14579","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1003","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1004 NTL DECISION","code_information":[{"code":"14580","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1004","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1007 AIM SPECIALTY","code_information":[{"code":"14581","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1007","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1008 CRANBERRY PEAK","code_information":[{"code":"14582","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1008","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1010 STANSON","code_information":[{"code":"14584","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1010","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1011 QLFD TOOL OTHR","code_information":[{"code":"14585","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1011","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1012 AGILEMD","code_information":[{"code":"14586","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1012","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1013 EVIDENCECARE","code_information":[{"code":"14587","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1013","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1014 INVENIQA SEMAN","code_information":[{"code":"14588","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1014","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1015 RELIANT MED GR","code_information":[{"code":"14589","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1015","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1016 SPEED OF CARE","code_information":[{"code":"14590","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1016","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1017 HEALTHHELP","code_information":[{"code":"14591","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1017","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1018 INFINX CDSM","code_information":[{"code":"14592","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1018","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1019 LOGICNETS","code_information":[{"code":"14593","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1019","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1020 CURBSIDE","code_information":[{"code":"14594","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1020","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1021 EHEALTHLINE","code_information":[{"code":"14595","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1021","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1022 INTERMOUNTAIN","code_information":[{"code":"14596","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1022","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1023 PERSIVIA","code_information":[{"code":"14597","type":"CDM"},{"code":"329","type":"RC"},{"code":"G1023","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"LOCM 100-199MG I 1ML","code_information":[{"code":"14598","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9965","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.33,"setting":"both","billing_class":"facility"}]},{"description":"LOCM 300-399MG I 1ML","code_information":[{"code":"14600","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":1.1,"setting":"both","billing_class":"facility"}]},{"description":"HOCM <=149MG I 1ML","code_information":[{"code":"14601","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.13,"setting":"both","billing_class":"facility"}]},{"description":"HOCM 150-199MG I 1ML","code_information":[{"code":"14602","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9959","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.13,"setting":"both","billing_class":"facility"}]},{"description":"CHEST 1 VIEW","code_information":[{"code":"14603","type":"CDM"},{"code":"324","type":"RC"},{"code":"71045","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":208.95,"discounted_cash":104.47,"setting":"both","billing_class":"facility"}]},{"description":"CHEST 2 VIEWS","code_information":[{"code":"14604","type":"CDM"},{"code":"324","type":"RC"},{"code":"71046","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.96,"discounted_cash":189.98,"setting":"both","billing_class":"facility"}]},{"description":"CHEST 3 VW F&L LORDO","code_information":[{"code":"14605","type":"CDM"},{"code":"324","type":"RC"},{"code":"71047","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"CHEST 4/>VIEWS","code_information":[{"code":"14606","type":"CDM"},{"code":"324","type":"RC"},{"code":"71048","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":436.97,"discounted_cash":218.49,"setting":"both","billing_class":"facility"}]},{"description":"ABDOMEN KUB 1 VW","code_information":[{"code":"14607","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":293.85,"discounted_cash":146.93,"setting":"both","billing_class":"facility"}]},{"description":"ABDOMEN FLAT&UPRIGHT","code_information":[{"code":"14608","type":"CDM"},{"code":"320","type":"RC"},{"code":"74019","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":265.95,"discounted_cash":132.97,"setting":"both","billing_class":"facility"}]},{"description":"XR NEPHROSTOGRAM","code_information":[{"code":"14609","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":1703.85,"discounted_cash":851.92,"setting":"both","billing_class":"facility"}]},{"description":"XR THORACOLUMBAR","code_information":[{"code":"14610","type":"CDM"},{"code":"320","type":"RC"},{"code":"72080","type":"CPT"},{"code":"684","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.44,"discounted_cash":128.22,"setting":"both","billing_class":"facility"}]},{"description":"BREAST CYST ASP","code_information":[{"code":"14611","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1013.23,"discounted_cash":506.62,"setting":"both","billing_class":"facility"}]},{"description":"US BX LYMPH NODE","code_information":[{"code":"14614","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":2718.05,"discounted_cash":1359.03,"setting":"both","billing_class":"facility"}]},{"description":"US BR BX STR 1ST","code_information":[{"code":"14628","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":2464.74,"discounted_cash":1232.37,"setting":"both","billing_class":"facility"}]},{"description":"US BR BX STR ADD","code_information":[{"code":"14629","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.29,"discounted_cash":221.65,"setting":"both","billing_class":"facility"}]},{"description":"US THORACENT W/IMAGE","code_information":[{"code":"14632","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1519.9,"discounted_cash":759.95,"setting":"both","billing_class":"facility"}]},{"description":"US BR LOC DVC 1ST","code_information":[{"code":"14634","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1673.15,"discounted_cash":836.58,"setting":"both","billing_class":"facility"}]},{"description":"ABD PARACENTISIS W/G","code_information":[{"code":"14653","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1773.21,"discounted_cash":886.61,"setting":"both","billing_class":"facility"}]},{"description":"BX RENAL PERCU","code_information":[{"code":"14654","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":2913.15,"discounted_cash":1456.58,"setting":"both","billing_class":"facility"}]},{"description":"US THYROID","code_information":[{"code":"14672","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1141.19,"discounted_cash":570.6,"setting":"both","billing_class":"facility"}]},{"description":"US CHEST","code_information":[{"code":"14674","type":"CDM"},{"code":"402","type":"RC"},{"code":"76604","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":596.17,"discounted_cash":298.08,"setting":"both","billing_class":"facility"}]},{"description":"US BREAST RT COMPL","code_information":[{"code":"14678","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":358.44,"discounted_cash":179.22,"setting":"both","billing_class":"facility"}]},{"description":"US BREAST LT COMPL","code_information":[{"code":"14679","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":358.44,"discounted_cash":179.22,"setting":"both","billing_class":"facility"}]},{"description":"US BREAST RT LTD","code_information":[{"code":"14680","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":358.44,"discounted_cash":179.22,"setting":"both","billing_class":"facility"}]},{"description":"US BREAST LT LTD","code_information":[{"code":"14681","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":358.44,"discounted_cash":179.22,"setting":"both","billing_class":"facility"}]},{"description":"US ABDOMEN COMPLETE","code_information":[{"code":"14682","type":"CDM"},{"code":"402","type":"RC"},{"code":"76700","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1076.56,"discounted_cash":538.28,"setting":"both","billing_class":"facility"}]},{"description":"US ABDOMEN LIMITED","code_information":[{"code":"14684","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":886.58,"discounted_cash":443.29,"setting":"both","billing_class":"facility"}]},{"description":"US RETROPERIT COMP","code_information":[{"code":"14694","type":"CDM"},{"code":"402","type":"RC"},{"code":"76770","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.76,"discounted_cash":315.38,"setting":"both","billing_class":"facility"}]},{"description":"US RETROPERITON LTD","code_information":[{"code":"14697","type":"CDM"},{"code":"402","type":"RC"},{"code":"76775","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":577.52,"discounted_cash":288.76,"setting":"both","billing_class":"facility"}]},{"description":"PREG UTERUS COMPLETE","code_information":[{"code":"14702","type":"CDM"},{"code":"402","type":"RC"},{"code":"76805","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":952.47,"discounted_cash":476.24,"setting":"both","billing_class":"facility"}]},{"description":"PREG UTERS MULT GEST","code_information":[{"code":"14703","type":"CDM"},{"code":"402","type":"RC"},{"code":"76810","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":357.13,"discounted_cash":178.56,"setting":"both","billing_class":"facility"}]},{"description":"PREG UTERUS LIMITED","code_information":[{"code":"14706","type":"CDM"},{"code":"402","type":"RC"},{"code":"76815","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"PREG UTERUS FU/REPEA","code_information":[{"code":"14708","type":"CDM"},{"code":"402","type":"RC"},{"code":"76816","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":525.64,"discounted_cash":262.82,"setting":"both","billing_class":"facility"}]},{"description":"FETAL BIOPHYS WO/NST","code_information":[{"code":"14710","type":"CDM"},{"code":"402","type":"RC"},{"code":"76819","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.34,"discounted_cash":347.67,"setting":"both","billing_class":"facility"}]},{"description":"US UMBILICL DPLR","code_information":[{"code":"14712","type":"CDM"},{"code":"402","type":"RC"},{"code":"76820","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":272.27,"discounted_cash":136.13,"setting":"both","billing_class":"facility"}]},{"description":"US TRANSVAGINAL","code_information":[{"code":"14713","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1155.14,"discounted_cash":577.57,"setting":"both","billing_class":"facility"}]},{"description":"US PELVIS NON OB","code_information":[{"code":"14714","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1350.14,"discounted_cash":675.07,"setting":"both","billing_class":"facility"}]},{"description":"US PELVIS NON OB LTD","code_information":[{"code":"14715","type":"CDM"},{"code":"402","type":"RC"},{"code":"76857","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":606.67,"discounted_cash":303.33,"setting":"both","billing_class":"facility"}]},{"description":"US SCROTUM & CONT","code_information":[{"code":"14716","type":"CDM"},{"code":"402","type":"RC"},{"code":"76870","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1047.46,"discounted_cash":523.73,"setting":"both","billing_class":"facility"}]},{"description":"US EXT NONVAS CMP RT","code_information":[{"code":"14719","type":"CDM"},{"code":"402","type":"RC"},{"code":"76881","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":932.14,"discounted_cash":466.07,"setting":"both","billing_class":"facility"}]},{"description":"US EXT NONVAS CMP LT","code_information":[{"code":"14720","type":"CDM"},{"code":"402","type":"RC"},{"code":"76881","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":932.14,"discounted_cash":466.07,"setting":"both","billing_class":"facility"}]},{"description":"US EXT NONVAS LTD RT","code_information":[{"code":"14721","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":415.86,"discounted_cash":207.93,"setting":"both","billing_class":"facility"}]},{"description":"US EXT NONVAS LTD LT","code_information":[{"code":"14722","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":415.86,"discounted_cash":207.93,"setting":"both","billing_class":"facility"}]},{"description":"DUPLEX EXTRACRAN LMT","code_information":[{"code":"14723","type":"CDM"},{"code":"921","type":"RC"},{"code":"93882","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.15,"discounted_cash":227.57,"setting":"both","billing_class":"facility"}]},{"description":"US GUIDE NDL BX/LOC","code_information":[{"code":"14731","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1395.13,"discounted_cash":697.57,"setting":"both","billing_class":"facility"}]},{"description":"US OB TRANSVAGINAL","code_information":[{"code":"14733","type":"CDM"},{"code":"402","type":"RC"},{"code":"76817","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.57,"discounted_cash":241.78,"setting":"both","billing_class":"facility"}]},{"description":"US OB 1ST TRMSTR SGL","code_information":[{"code":"14738","type":"CDM"},{"code":"402","type":"RC"},{"code":"76801","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":791.01,"discounted_cash":395.5,"setting":"both","billing_class":"facility"}]},{"description":"US OB 1ST TRMSTR ADD","code_information":[{"code":"14739","type":"CDM"},{"code":"402","type":"RC"},{"code":"76802","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":309.06,"discounted_cash":154.53,"setting":"both","billing_class":"facility"}]},{"description":"DPLX SC XCRN ART CMP","code_information":[{"code":"14740","type":"CDM"},{"code":"921","type":"RC"},{"code":"93880","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.31,"discounted_cash":367.65,"setting":"both","billing_class":"facility"}]},{"description":"DUPLX SCAN VEINS COM","code_information":[{"code":"14742","type":"CDM"},{"code":"921","type":"RC"},{"code":"93970","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":897.92,"discounted_cash":448.96,"setting":"both","billing_class":"facility"}]},{"description":"DUP SCAN HEMO ACCESS","code_information":[{"code":"14743","type":"CDM"},{"code":"921","type":"RC"},{"code":"93990","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":502.17,"discounted_cash":251.09,"setting":"both","billing_class":"facility"}]},{"description":"EXT ART STDY 1-2 LVL","code_information":[{"code":"14747","type":"CDM"},{"code":"921","type":"RC"},{"code":"93922","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":669.11,"discounted_cash":334.56,"setting":"both","billing_class":"facility"}]},{"description":"DPLX SC LW EXT ART C","code_information":[{"code":"14748","type":"CDM"},{"code":"921","type":"RC"},{"code":"93925","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.31,"discounted_cash":367.65,"setting":"both","billing_class":"facility"}]},{"description":"DUPLX SCN LOW ART UN","code_information":[{"code":"14749","type":"CDM"},{"code":"921","type":"RC"},{"code":"93926","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":747.28,"discounted_cash":373.64,"setting":"both","billing_class":"facility"}]},{"description":"DPLX SC UPP ARTS CP","code_information":[{"code":"14750","type":"CDM"},{"code":"921","type":"RC"},{"code":"93930","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.31,"discounted_cash":367.65,"setting":"both","billing_class":"facility"}]},{"description":"DUPLX SCN UPP ART UN","code_information":[{"code":"14751","type":"CDM"},{"code":"921","type":"RC"},{"code":"93931","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":647.85,"discounted_cash":323.93,"setting":"both","billing_class":"facility"}]},{"description":"DUPLX SCAN VEINS UNI","code_information":[{"code":"14752","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":568.38,"discounted_cash":284.19,"setting":"both","billing_class":"facility"}]},{"description":"ABDOMINAL SCAN DUPLX","code_information":[{"code":"14753","type":"CDM"},{"code":"921","type":"RC"},{"code":"93975","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1127.45,"discounted_cash":563.73,"setting":"both","billing_class":"facility"}]},{"description":"ABD SCAN DUPLEX LTD","code_information":[{"code":"14754","type":"CDM"},{"code":"921","type":"RC"},{"code":"93976","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":783.96,"discounted_cash":391.98,"setting":"both","billing_class":"facility"}]},{"description":"DUP AORT/IVC/ILI CMP","code_information":[{"code":"14755","type":"CDM"},{"code":"921","type":"RC"},{"code":"93978","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":722.04,"discounted_cash":361.02,"setting":"both","billing_class":"facility"}]},{"description":"DUP AORT/IVC/ILI LTD","code_information":[{"code":"14756","type":"CDM"},{"code":"921","type":"RC"},{"code":"93979","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":702.24,"discounted_cash":351.12,"setting":"both","billing_class":"facility"}]},{"description":"DUPLEX HEMO CMPL BIL","code_information":[{"code":"14757","type":"CDM"},{"code":"402","type":"RC"},{"code":"93985","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":929.63,"discounted_cash":464.81,"setting":"both","billing_class":"facility"}]},{"description":"DUPLEX HEMO CMPL UNI","code_information":[{"code":"14759","type":"CDM"},{"code":"402","type":"RC"},{"code":"93986","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":447.05,"discounted_cash":223.53,"setting":"both","billing_class":"facility"}]},{"description":"US ABDL AORTA SCREEN","code_information":[{"code":"14760","type":"CDM"},{"code":"402","type":"RC"},{"code":"76706","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":447.05,"discounted_cash":223.53,"setting":"both","billing_class":"facility"}]},{"description":"US ASPIRATION","code_information":[{"code":"14761","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1133.3,"discounted_cash":566.65,"setting":"both","billing_class":"facility"}]},{"description":"EXT ART STDY U/L MUL","code_information":[{"code":"14768","type":"CDM"},{"code":"921","type":"RC"},{"code":"93923","type":"CPT"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":673.82,"discounted_cash":336.91,"setting":"both","billing_class":"facility"}]},{"description":"US FNA GUIDANCE","code_information":[{"code":"14789","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1772.79,"discounted_cash":886.39,"setting":"both","billing_class":"facility"}]},{"description":"LITHOTRPSY ESW","code_information":[{"code":"14792","type":"CDM"},{"code":"790","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"711","type":"LOCAL"}],"standard_charges":[{"gross_charge":16561.73,"discounted_cash":8280.86,"setting":"both","billing_class":"facility"}]},{"description":"LITHOTRIP ESW BILAT","code_information":[{"code":"14793","type":"CDM"},{"code":"790","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"711","type":"LOCAL"}],"standard_charges":[{"gross_charge":20072.83,"discounted_cash":10036.42,"setting":"both","billing_class":"facility"}]},{"description":"CYSTO PROC/W ESWL","code_information":[{"code":"14794","type":"CDM"},{"code":"790","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"711","type":"LOCAL"}],"standard_charges":[{"gross_charge":4554.74,"discounted_cash":2277.37,"setting":"both","billing_class":"facility"}]},{"description":"MAMMO DIAG UNI LT","code_information":[{"code":"14795","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"CPT"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":155.0,"setting":"both","billing_class":"facility"}]},{"description":"MAMMO DIAG UNI RT","code_information":[{"code":"14796","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"CPT"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":155.0,"setting":"both","billing_class":"facility"}]},{"description":"MAMMO DIAG BIL","code_information":[{"code":"14797","type":"CDM"},{"code":"401","type":"RC"},{"code":"77066","type":"CPT"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":406.77,"discounted_cash":203.38,"setting":"both","billing_class":"facility"}]},{"description":"MA DIG DIAG TOMO","code_information":[{"code":"14798","type":"CDM"},{"code":"401","type":"RC"},{"code":"G0279","type":"HCPCS"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":101.31,"discounted_cash":50.66,"setting":"both","billing_class":"facility"}]},{"description":"MA DIG SCREEN TOMO","code_information":[{"code":"14799","type":"CDM"},{"code":"403","type":"RC"},{"code":"77063","type":"CPT"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":101.31,"discounted_cash":50.66,"setting":"both","billing_class":"facility"}]},{"description":"STEREO BX ADD STE RT","code_information":[{"code":"14800","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":1289.16,"discounted_cash":644.58,"setting":"both","billing_class":"facility"}]},{"description":"STEREO BX ADD STE LT","code_information":[{"code":"14801","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":1289.16,"discounted_cash":644.58,"setting":"both","billing_class":"facility"}]},{"description":"MAMM SCRN BILAT CAD","code_information":[{"code":"14808","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"CPT"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":392.14,"discounted_cash":196.07,"setting":"both","billing_class":"facility"}]},{"description":"MAMMO DUCTOGRM/S RT","code_information":[{"code":"14814","type":"CDM"},{"code":"320","type":"RC"},{"code":"77053","type":"CPT"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":1098.14,"discounted_cash":549.07,"setting":"both","billing_class":"facility"}]},{"description":"MAMMO DUCTOGRM/S LT","code_information":[{"code":"14815","type":"CDM"},{"code":"320","type":"RC"},{"code":"77053","type":"CPT"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":1098.14,"discounted_cash":549.07,"setting":"both","billing_class":"facility"}]},{"description":"MAMMO DUCTOGRM/M RT","code_information":[{"code":"14816","type":"CDM"},{"code":"320","type":"RC"},{"code":"77054","type":"CPT"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":1192.03,"discounted_cash":596.01,"setting":"both","billing_class":"facility"}]},{"description":"MAMMO DUCTOGRM/M LT","code_information":[{"code":"14817","type":"CDM"},{"code":"320","type":"RC"},{"code":"77054","type":"CPT"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":1192.03,"discounted_cash":596.01,"setting":"both","billing_class":"facility"}]},{"description":"MA BR BX STR 1ST RT","code_information":[{"code":"14818","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":2578.33,"discounted_cash":1289.16,"setting":"both","billing_class":"facility"}]},{"description":"MA BR BX STR 1ST LT","code_information":[{"code":"14819","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":2578.33,"discounted_cash":1289.16,"setting":"both","billing_class":"facility"}]},{"description":"MA BR LOC DVC 1ST RT","code_information":[{"code":"14822","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":1750.22,"discounted_cash":875.11,"setting":"both","billing_class":"facility"}]},{"description":"MA BR LOC DVC 1ST LT","code_information":[{"code":"14823","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":1750.22,"discounted_cash":875.11,"setting":"both","billing_class":"facility"}]},{"description":"MAMMO SURG SPECIMEN","code_information":[{"code":"14826","type":"CDM"},{"code":"320","type":"RC"},{"code":"76098","type":"CPT"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":890.29,"discounted_cash":445.14,"setting":"both","billing_class":"facility"}]},{"description":"MARKED ADDTNL LESION","code_information":[{"code":"14831","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"676","type":"LOCAL"}],"standard_charges":[{"gross_charge":823.25,"discounted_cash":411.63,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LVL I 1ST 30 MN","code_information":[{"code":"14925","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"854","type":"LOCAL"}],"standard_charges":[{"gross_charge":1370.31,"discounted_cash":685.15,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LVL I ADDL 15M","code_information":[{"code":"14926","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"854","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.81,"discounted_cash":189.91,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LVL II 1ST 30M","code_information":[{"code":"14927","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"854","type":"LOCAL"}],"standard_charges":[{"gross_charge":1897.56,"discounted_cash":948.78,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LVL II ADDL 15M","code_information":[{"code":"14928","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"854","type":"LOCAL"}],"standard_charges":[{"gross_charge":601.03,"discounted_cash":300.51,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LVL III 1ST 30","code_information":[{"code":"14929","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"854","type":"LOCAL"}],"standard_charges":[{"gross_charge":2423.04,"discounted_cash":1211.52,"setting":"both","billing_class":"facility"}]},{"description":"ENDO LVL III ADD 15M","code_information":[{"code":"14930","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"854","type":"LOCAL"}],"standard_charges":[{"gross_charge":829.48,"discounted_cash":414.74,"setting":"both","billing_class":"facility"}]},{"description":"ESOPH/GAST REF CAPSL","code_information":[{"code":"14935","type":"CDM"},{"code":"750","type":"RC"},{"code":"91035","type":"CPT"},{"code":"854","type":"LOCAL"}],"standard_charges":[{"gross_charge":952.47,"discounted_cash":476.24,"setting":"both","billing_class":"facility"}]},{"description":"MRI TMJ","code_information":[{"code":"14942","type":"CDM"},{"code":"610","type":"RC"},{"code":"70336","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":835.84,"discounted_cash":417.92,"setting":"both","billing_class":"facility"}]},{"description":"MRI ORBIT/FACE &NECK","code_information":[{"code":"14944","type":"CDM"},{"code":"611","type":"RC"},{"code":"70540","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3104.38,"discounted_cash":1552.19,"setting":"both","billing_class":"facility"}]},{"description":"MRI ORB/FACE/NCK W/","code_information":[{"code":"14945","type":"CDM"},{"code":"611","type":"RC"},{"code":"70542","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3104.38,"discounted_cash":1552.19,"setting":"both","billing_class":"facility"}]},{"description":"MRI ORB/FACE/NCKWO/W","code_information":[{"code":"14946","type":"CDM"},{"code":"611","type":"RC"},{"code":"70543","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3206.95,"discounted_cash":1603.47,"setting":"both","billing_class":"facility"}]},{"description":"MRA HEAD W/O","code_information":[{"code":"14947","type":"CDM"},{"code":"611","type":"RC"},{"code":"70544","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2405.22,"discounted_cash":1202.61,"setting":"both","billing_class":"facility"}]},{"description":"MRA HEAD W","code_information":[{"code":"14948","type":"CDM"},{"code":"615","type":"RC"},{"code":"70545","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3165.51,"discounted_cash":1582.76,"setting":"both","billing_class":"facility"}]},{"description":"MRA HEAD WO/W","code_information":[{"code":"14949","type":"CDM"},{"code":"615","type":"RC"},{"code":"70546","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":4507.71,"discounted_cash":2253.86,"setting":"both","billing_class":"facility"}]},{"description":"MRA NECK W/O","code_information":[{"code":"14950","type":"CDM"},{"code":"615","type":"RC"},{"code":"70547","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2317.81,"discounted_cash":1158.9,"setting":"both","billing_class":"facility"}]},{"description":"MRA NECK W","code_information":[{"code":"14951","type":"CDM"},{"code":"615","type":"RC"},{"code":"70548","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3165.51,"discounted_cash":1582.76,"setting":"both","billing_class":"facility"}]},{"description":"MRA NECK WO/W","code_information":[{"code":"14952","type":"CDM"},{"code":"615","type":"RC"},{"code":"70549","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3210.76,"discounted_cash":1605.38,"setting":"both","billing_class":"facility"}]},{"description":"MRI BRAIN W/O","code_information":[{"code":"14953","type":"CDM"},{"code":"611","type":"RC"},{"code":"70551","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3109.45,"discounted_cash":1554.72,"setting":"both","billing_class":"facility"}]},{"description":"MRI BRAIN W","code_information":[{"code":"14954","type":"CDM"},{"code":"611","type":"RC"},{"code":"70552","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2335.68,"discounted_cash":1167.84,"setting":"both","billing_class":"facility"}]},{"description":"MRI BRAIN W/W/O","code_information":[{"code":"14955","type":"CDM"},{"code":"611","type":"RC"},{"code":"70553","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":4481.12,"discounted_cash":2240.56,"setting":"both","billing_class":"facility"}]},{"description":"MRI CHEST W/O","code_information":[{"code":"14958","type":"CDM"},{"code":"610","type":"RC"},{"code":"71550","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3023.29,"discounted_cash":1511.64,"setting":"both","billing_class":"facility"}]},{"description":"MRI CHEST W","code_information":[{"code":"14959","type":"CDM"},{"code":"610","type":"RC"},{"code":"71551","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3023.29,"discounted_cash":1511.64,"setting":"both","billing_class":"facility"}]},{"description":"MRI CHEST WO/W","code_information":[{"code":"14960","type":"CDM"},{"code":"610","type":"RC"},{"code":"71552","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":4622.98,"discounted_cash":2311.49,"setting":"both","billing_class":"facility"}]},{"description":"MRI C-SPINE W/O","code_information":[{"code":"14968","type":"CDM"},{"code":"612","type":"RC"},{"code":"72141","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3300.68,"discounted_cash":1650.34,"setting":"both","billing_class":"facility"}]},{"description":"MRI C-SPINE W","code_information":[{"code":"14969","type":"CDM"},{"code":"612","type":"RC"},{"code":"72142","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3023.29,"discounted_cash":1511.64,"setting":"both","billing_class":"facility"}]},{"description":"MRI T-SPINE W/O","code_information":[{"code":"14970","type":"CDM"},{"code":"612","type":"RC"},{"code":"72146","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3412.19,"discounted_cash":1706.1,"setting":"both","billing_class":"facility"}]},{"description":"MRI T-SPINE W","code_information":[{"code":"14971","type":"CDM"},{"code":"612","type":"RC"},{"code":"72147","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3023.29,"discounted_cash":1511.64,"setting":"both","billing_class":"facility"}]},{"description":"MRI L-SPINE W/O","code_information":[{"code":"14972","type":"CDM"},{"code":"612","type":"RC"},{"code":"72148","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3333.6,"discounted_cash":1666.8,"setting":"both","billing_class":"facility"}]},{"description":"MRI L-SPINE W","code_information":[{"code":"14973","type":"CDM"},{"code":"612","type":"RC"},{"code":"72149","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3174.34,"discounted_cash":1587.17,"setting":"both","billing_class":"facility"}]},{"description":"MRI C-SPINE W/W/O","code_information":[{"code":"14974","type":"CDM"},{"code":"612","type":"RC"},{"code":"72156","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":4465.91,"discounted_cash":2232.95,"setting":"both","billing_class":"facility"}]},{"description":"MRI T-SPINE W WO","code_information":[{"code":"14975","type":"CDM"},{"code":"612","type":"RC"},{"code":"72157","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3852.92,"discounted_cash":1926.46,"setting":"both","billing_class":"facility"}]},{"description":"MRI L-SPINE W/W/O","code_information":[{"code":"14976","type":"CDM"},{"code":"612","type":"RC"},{"code":"72158","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":4425.42,"discounted_cash":2212.71,"setting":"both","billing_class":"facility"}]},{"description":"MRI PELVIS W/O","code_information":[{"code":"14978","type":"CDM"},{"code":"610","type":"RC"},{"code":"72195","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2864.97,"discounted_cash":1432.48,"setting":"both","billing_class":"facility"}]},{"description":"MRI PELVIS W","code_information":[{"code":"14979","type":"CDM"},{"code":"610","type":"RC"},{"code":"72196","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3023.29,"discounted_cash":1511.64,"setting":"both","billing_class":"facility"}]},{"description":"MRI PELVIS WO/W","code_information":[{"code":"14980","type":"CDM"},{"code":"610","type":"RC"},{"code":"72197","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2954.89,"discounted_cash":1477.44,"setting":"both","billing_class":"facility"}]},{"description":"MRA PELVIS WO/W","code_information":[{"code":"14983","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8920","type":"HCPCS"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2976.47,"discounted_cash":1488.23,"setting":"both","billing_class":"facility"}]},{"description":"MRI UP EXT W/O RT","code_information":[{"code":"14984","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3309.57,"discounted_cash":1654.79,"setting":"both","billing_class":"facility"}]},{"description":"MRI UP EXT W RT","code_information":[{"code":"14985","type":"CDM"},{"code":"610","type":"RC"},{"code":"73219","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3166.45,"discounted_cash":1583.22,"setting":"both","billing_class":"facility"}]},{"description":"MRI UP EXT WO/W RT","code_information":[{"code":"14986","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":4622.98,"discounted_cash":2311.49,"setting":"both","billing_class":"facility"}]},{"description":"MRI UP EXT W/O LT","code_information":[{"code":"14987","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3309.57,"discounted_cash":1654.79,"setting":"both","billing_class":"facility"}]},{"description":"MRI UP EXT W LT","code_information":[{"code":"14988","type":"CDM"},{"code":"610","type":"RC"},{"code":"73219","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3166.45,"discounted_cash":1583.22,"setting":"both","billing_class":"facility"}]},{"description":"MRI UP EXT WO/W LT","code_information":[{"code":"14989","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":4267.1,"discounted_cash":2133.55,"setting":"both","billing_class":"facility"}]},{"description":"MRI JT UP EXT W/O LT","code_information":[{"code":"14990","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3436.22,"discounted_cash":1718.11,"setting":"both","billing_class":"facility"}]},{"description":"MRI JT UP EXT W LT","code_information":[{"code":"14991","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2640.82,"discounted_cash":1320.41,"setting":"both","billing_class":"facility"}]},{"description":"MRI JT U-EXT WOW LT","code_information":[{"code":"14992","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":4622.98,"discounted_cash":2311.49,"setting":"both","billing_class":"facility"}]},{"description":"MRI JT UP EXT W/O RT","code_information":[{"code":"14993","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3436.22,"discounted_cash":1718.11,"setting":"both","billing_class":"facility"}]},{"description":"MRI JT UP EXT W RT","code_information":[{"code":"14994","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2640.82,"discounted_cash":1320.41,"setting":"both","billing_class":"facility"}]},{"description":"MRI JT U-EXT WO/W RT","code_information":[{"code":"14995","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":4622.98,"discounted_cash":2311.49,"setting":"both","billing_class":"facility"}]},{"description":"MRI LWR EXT W/O RT","code_information":[{"code":"14997","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3144.88,"discounted_cash":1572.44,"setting":"both","billing_class":"facility"}]},{"description":"MRI LWR EXT W RT","code_information":[{"code":"14998","type":"CDM"},{"code":"610","type":"RC"},{"code":"73719","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2842.19,"discounted_cash":1421.1,"setting":"both","billing_class":"facility"}]},{"description":"MRI LWR EXT W/WO RT","code_information":[{"code":"14999","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3293.06,"discounted_cash":1646.53,"setting":"both","billing_class":"facility"}]},{"description":"APPL UNNA BOOT LT","code_information":[{"code":"15","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.05,"discounted_cash":227.53,"setting":"both","billing_class":"facility"}]},{"description":"MRI LWR EXT W/O LT","code_information":[{"code":"15000","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3144.88,"discounted_cash":1572.44,"setting":"both","billing_class":"facility"}]},{"description":"MRI LWR EXT W LT","code_information":[{"code":"15001","type":"CDM"},{"code":"610","type":"RC"},{"code":"73719","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2842.19,"discounted_cash":1421.1,"setting":"both","billing_class":"facility"}]},{"description":"MRI LWR EXT W/WO LT","code_information":[{"code":"15002","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3296.06,"discounted_cash":1648.03,"setting":"both","billing_class":"facility"}]},{"description":"MRI JT L-EXT W/O LT","code_information":[{"code":"15003","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3414.69,"discounted_cash":1707.35,"setting":"both","billing_class":"facility"}]},{"description":"MRI JT L-EXT W LT","code_information":[{"code":"15004","type":"CDM"},{"code":"610","type":"RC"},{"code":"73722","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3174.34,"discounted_cash":1587.17,"setting":"both","billing_class":"facility"}]},{"description":"MRI JT L-EXT WO/W LT","code_information":[{"code":"15005","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3459.0,"discounted_cash":1729.5,"setting":"both","billing_class":"facility"}]},{"description":"MRI JT L-EXT W/O RT","code_information":[{"code":"15006","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3414.69,"discounted_cash":1707.35,"setting":"both","billing_class":"facility"}]},{"description":"MRI JT L-EXT W RT","code_information":[{"code":"15007","type":"CDM"},{"code":"610","type":"RC"},{"code":"73722","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3014.56,"discounted_cash":1507.28,"setting":"both","billing_class":"facility"}]},{"description":"MRI JT L-EXT WO/W RT","code_information":[{"code":"15008","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3459.0,"discounted_cash":1729.5,"setting":"both","billing_class":"facility"}]},{"description":"MRI JT L-EXT W/O BL","code_information":[{"code":"15009","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3809.86,"discounted_cash":1904.93,"setting":"both","billing_class":"facility"}]},{"description":"MRA LWR EXT W/O","code_information":[{"code":"15010","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8913","type":"HCPCS"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3168.96,"discounted_cash":1584.48,"setting":"both","billing_class":"facility"}]},{"description":"MRA LWR EXT W/C RT","code_information":[{"code":"15011","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8912","type":"HCPCS"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3168.96,"discounted_cash":1584.48,"setting":"both","billing_class":"facility"}]},{"description":"MRA LWR EXT WO/W RT","code_information":[{"code":"15012","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8914","type":"HCPCS"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3168.96,"discounted_cash":1584.48,"setting":"both","billing_class":"facility"}]},{"description":"MRA LWR EXT WO/W LT","code_information":[{"code":"15013","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8914","type":"HCPCS"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3168.96,"discounted_cash":1584.48,"setting":"both","billing_class":"facility"}]},{"description":"MRA LWR EXT W/C LT","code_information":[{"code":"15014","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8912","type":"HCPCS"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3168.96,"discounted_cash":1584.48,"setting":"both","billing_class":"facility"}]},{"description":"MRI ABD W/O","code_information":[{"code":"15015","type":"CDM"},{"code":"610","type":"RC"},{"code":"74181","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3208.25,"discounted_cash":1604.13,"setting":"both","billing_class":"facility"}]},{"description":"MRI ABD W","code_information":[{"code":"15016","type":"CDM"},{"code":"610","type":"RC"},{"code":"74182","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3174.34,"discounted_cash":1587.17,"setting":"both","billing_class":"facility"}]},{"description":"MRI ABD WO/W","code_information":[{"code":"15017","type":"CDM"},{"code":"610","type":"RC"},{"code":"74183","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3723.75,"discounted_cash":1861.88,"setting":"both","billing_class":"facility"}]},{"description":"MRA ABD W/C","code_information":[{"code":"15020","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8900","type":"HCPCS"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2976.47,"discounted_cash":1488.23,"setting":"both","billing_class":"facility"}]},{"description":"MRA ABD W/O","code_information":[{"code":"15021","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8901","type":"HCPCS"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2976.47,"discounted_cash":1488.23,"setting":"both","billing_class":"facility"}]},{"description":"MRA ABD WO/W","code_information":[{"code":"15022","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8902","type":"HCPCS"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2828.34,"discounted_cash":1414.17,"setting":"both","billing_class":"facility"}]},{"description":"MRI BRST BI W/O","code_information":[{"code":"15031","type":"CDM"},{"code":"610","type":"RC"},{"code":"77047","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2398.92,"discounted_cash":1199.46,"setting":"both","billing_class":"facility"}]},{"description":"MRI BRST BI WO/W","code_information":[{"code":"15033","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8908","type":"HCPCS"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2398.85,"discounted_cash":1199.42,"setting":"both","billing_class":"facility"}]},{"description":"INJ GAD CTRST PER ML","code_information":[{"code":"15037","type":"CDM"},{"code":"255","type":"RC"},{"code":"A9579","type":"HCPCS"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":5.67,"setting":"both","billing_class":"facility"}]},{"description":"CREATININE POC","code_information":[{"code":"15038","type":"CDM"},{"code":"300","type":"RC"},{"code":"82565","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.1,"discounted_cash":14.55,"setting":"both","billing_class":"facility"}]},{"description":"DRG SCRN AMPHETA 1/2","code_information":[{"code":"15041","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.85,"discounted_cash":218.93,"setting":"both","billing_class":"facility"}]},{"description":"HBB FULL GENE SEQUEN","code_information":[{"code":"15042","type":"CDM"},{"code":"310","type":"RC"},{"code":"81364","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1137.95,"discounted_cash":568.98,"setting":"both","billing_class":"facility"}]},{"description":"VIRUS INOCULAT SHELL","code_information":[{"code":"15044","type":"CDM"},{"code":"306","type":"RC"},{"code":"87254","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":93.7,"discounted_cash":46.85,"setting":"both","billing_class":"facility"}]},{"description":"DNA/RNA AMPLIFIED PR","code_information":[{"code":"15045","type":"CDM"},{"code":"306","type":"RC"},{"code":"87150","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":156.7,"discounted_cash":78.35,"setting":"both","billing_class":"facility"}]},{"description":"MOPATH PROCEDURE LEV","code_information":[{"code":"15046","type":"CDM"},{"code":"310","type":"RC"},{"code":"81408","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":5733.0,"discounted_cash":2866.5,"setting":"both","billing_class":"facility"}]},{"description":"PMS2 GENE DUP/DELET","code_information":[{"code":"15047","type":"CDM"},{"code":"310","type":"RC"},{"code":"81319","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.55,"discounted_cash":389.27,"setting":"both","billing_class":"facility"}]},{"description":"CYSTIC FIBROSIS PNL","code_information":[{"code":"15048","type":"CDM"},{"code":"300","type":"RC"},{"code":"81220","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":154.65,"discounted_cash":77.33,"setting":"both","billing_class":"facility"}]},{"description":"MSH6 GENE DUP/DELETE","code_information":[{"code":"15049","type":"CDM"},{"code":"310","type":"RC"},{"code":"81300","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":910.6,"discounted_cash":455.3,"setting":"both","billing_class":"facility"}]},{"description":"MSH2 GENE DUP/DELETE","code_information":[{"code":"15050","type":"CDM"},{"code":"310","type":"RC"},{"code":"81297","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":816.1,"discounted_cash":408.05,"setting":"both","billing_class":"facility"}]},{"description":"APC GENE DELET/DUPLI","code_information":[{"code":"15051","type":"CDM"},{"code":"310","type":"RC"},{"code":"81203","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2983.85,"discounted_cash":1491.92,"setting":"both","billing_class":"facility"}]},{"description":"MTHFR PANEL","code_information":[{"code":"15053","type":"CDM"},{"code":"300","type":"RC"},{"code":"81291","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":244.0,"setting":"both","billing_class":"facility"}]},{"description":"MLH1 GENE DUP/DELETE","code_information":[{"code":"15054","type":"CDM"},{"code":"310","type":"RC"},{"code":"81294","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":774.35,"discounted_cash":387.18,"setting":"both","billing_class":"facility"}]},{"description":"PTEN GENE DUP/DELET","code_information":[{"code":"15055","type":"CDM"},{"code":"310","type":"RC"},{"code":"81323","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1051.85,"discounted_cash":525.92,"setting":"both","billing_class":"facility"}]},{"description":"PMS2 GENE FULL SEQ","code_information":[{"code":"15056","type":"CDM"},{"code":"310","type":"RC"},{"code":"81317","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.4,"discounted_cash":1077.7,"setting":"both","billing_class":"facility"}]},{"description":"MSH6 GENE FULL SEQ","code_information":[{"code":"15057","type":"CDM"},{"code":"300","type":"RC"},{"code":"81298","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2045.15,"discounted_cash":1022.58,"setting":"both","billing_class":"facility"}]},{"description":"MOLECULAR PATH LVL 4","code_information":[{"code":"15058","type":"CDM"},{"code":"300","type":"RC"},{"code":"81403","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":534.6,"discounted_cash":267.3,"setting":"both","billing_class":"facility"}]},{"description":"APC GENE FULL SEQ","code_information":[{"code":"15059","type":"CDM"},{"code":"310","type":"RC"},{"code":"81201","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2485.35,"discounted_cash":1242.67,"setting":"both","billing_class":"facility"}]},{"description":"MSH2 GENE FULL SEQ","code_information":[{"code":"15061","type":"CDM"},{"code":"300","type":"RC"},{"code":"81295","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1338.2,"discounted_cash":669.1,"setting":"both","billing_class":"facility"}]},{"description":"MLH1 GENE FULL SEQ","code_information":[{"code":"15062","type":"CDM"},{"code":"310","type":"RC"},{"code":"81292","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.95,"discounted_cash":1075.97,"setting":"both","billing_class":"facility"}]},{"description":"KRAS MUTATION PANEL","code_information":[{"code":"15063","type":"CDM"},{"code":"300","type":"RC"},{"code":"81275","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.95,"discounted_cash":285.98,"setting":"both","billing_class":"facility"}]},{"description":"PALB2 GENE FULL GENE","code_information":[{"code":"15064","type":"CDM"},{"code":"310","type":"RC"},{"code":"81307","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.4,"discounted_cash":1077.7,"setting":"both","billing_class":"facility"}]},{"description":"TP53 GENE FULL GENE","code_information":[{"code":"15065","type":"CDM"},{"code":"310","type":"RC"},{"code":"81351","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2045.15,"discounted_cash":1022.58,"setting":"both","billing_class":"facility"}]},{"description":"PTEN GENE FULL SEQ","code_information":[{"code":"15066","type":"CDM"},{"code":"310","type":"RC"},{"code":"81321","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1911.8,"discounted_cash":955.9,"setting":"both","billing_class":"facility"}]},{"description":"IG LIGHT CHAIN FREE","code_information":[{"code":"15067","type":"CDM"},{"code":"301","type":"RC"},{"code":"83521","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.7,"discounted_cash":41.35,"setting":"both","billing_class":"facility"}]},{"description":"CNS DNA AMPPRB 12-25","code_information":[{"code":"15071","type":"CDM"},{"code":"306","type":"RC"},{"code":"87483","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1461.35,"discounted_cash":730.67,"setting":"both","billing_class":"facility"}]},{"description":"HHV 6 DNA AMP PROBE","code_information":[{"code":"15072","type":"CDM"},{"code":"306","type":"RC"},{"code":"87532","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":156.7,"discounted_cash":78.35,"setting":"both","billing_class":"facility"}]},{"description":"NFCT 22 TRG SARSCOV2","code_information":[{"code":"15074","type":"CDM"},{"code":"306","type":"RC"},{"code":"0202U","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1461.35,"discounted_cash":730.67,"setting":"both","billing_class":"facility"}]},{"description":"PAP THN PRP W/MN SCR","code_information":[{"code":"15075","type":"CDM"},{"code":"311","type":"RC"},{"code":"88175","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.35,"discounted_cash":75.67,"setting":"both","billing_class":"facility"}]},{"description":"EML4 ALK GENE FUSN","code_information":[{"code":"15077","type":"CDM"},{"code":"300","type":"RC"},{"code":"81401","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":839.95,"discounted_cash":419.98,"setting":"both","billing_class":"facility"}]},{"description":"EGFR MUTATION PANEL","code_information":[{"code":"15078","type":"CDM"},{"code":"300","type":"RC"},{"code":"81235","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1216.6,"discounted_cash":608.3,"setting":"both","billing_class":"facility"}]},{"description":"FMR1 GENE DETECTION","code_information":[{"code":"15079","type":"CDM"},{"code":"310","type":"RC"},{"code":"81243","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":236.05,"discounted_cash":118.03,"setting":"both","billing_class":"facility"}]},{"description":"JAK2 V617F PANEL","code_information":[{"code":"15080","type":"CDM"},{"code":"300","type":"RC"},{"code":"81270","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility"}]},{"description":"PT GENE MUTATION PNL","code_information":[{"code":"15081","type":"CDM"},{"code":"300","type":"RC"},{"code":"81240","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility"}]},{"description":"BRCAVANTAGE COMP","code_information":[{"code":"15083","type":"CDM"},{"code":"310","type":"RC"},{"code":"81162","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":4666.3,"discounted_cash":2333.15,"setting":"both","billing_class":"facility"}]},{"description":"GI PATHOGEN 22 TARGE","code_information":[{"code":"15084","type":"CDM"},{"code":"306","type":"RC"},{"code":"87507","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1213.6,"discounted_cash":606.8,"setting":"both","billing_class":"facility"}]},{"description":"ENTEROVIRUS PROBE&RE","code_information":[{"code":"15085","type":"CDM"},{"code":"306","type":"RC"},{"code":"87498","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":149.35,"discounted_cash":74.67,"setting":"both","billing_class":"facility"}]},{"description":"ASSAY PYRUVTE KINASE","code_information":[{"code":"15086","type":"CDM"},{"code":"301","type":"RC"},{"code":"84220","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.25,"discounted_cash":24.13,"setting":"both","billing_class":"facility"}]},{"description":"HEREDITRY HEMOCHROM","code_information":[{"code":"15087","type":"CDM"},{"code":"300","type":"RC"},{"code":"81256","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.95,"discounted_cash":227.97,"setting":"both","billing_class":"facility"}]},{"description":"BRAF MUTATION ANALYS","code_information":[{"code":"15088","type":"CDM"},{"code":"300","type":"RC"},{"code":"81210","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2087.85,"discounted_cash":1043.92,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR V MUTATN ANLY","code_information":[{"code":"15089","type":"CDM"},{"code":"300","type":"RC"},{"code":"81241","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.65,"discounted_cash":63.33,"setting":"both","billing_class":"facility"}]},{"description":"CALRTCULN MUTATIN AN","code_information":[{"code":"15090","type":"CDM"},{"code":"310","type":"RC"},{"code":"81219","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1129.25,"discounted_cash":564.63,"setting":"both","billing_class":"facility"}]},{"description":"OPIOIDS & OPIATE 1/2","code_information":[{"code":"15092","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"CNSLT PREP SPEC","code_information":[{"code":"15096","type":"CDM"},{"code":"310","type":"RC"},{"code":"88321","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":118.75,"setting":"both","billing_class":"facility"}]},{"description":"DNA/RNA SEQUENCING","code_information":[{"code":"15097","type":"CDM"},{"code":"306","type":"RC"},{"code":"87153","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":441.25,"discounted_cash":220.63,"setting":"both","billing_class":"facility"}]},{"description":"POC BASIC METBOL PNL","code_information":[{"code":"15102","type":"CDM"},{"code":"300","type":"RC"},{"code":"80047","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":155.15,"discounted_cash":77.58,"setting":"both","billing_class":"facility"}]},{"description":"BASIC METABOLIC PANE","code_information":[{"code":"15103","type":"CDM"},{"code":"300","type":"RC"},{"code":"80048","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":112.7,"discounted_cash":56.35,"setting":"both","billing_class":"facility"}]},{"description":"GENERAL HEALTH PANEL","code_information":[{"code":"15106","type":"CDM"},{"code":"300","type":"RC"},{"code":"80050","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":415.75,"discounted_cash":207.88,"setting":"both","billing_class":"facility"}]},{"description":"PSA, COMPLEXED","code_information":[{"code":"15107","type":"CDM"},{"code":"300","type":"RC"},{"code":"84152","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":108.15,"discounted_cash":54.08,"setting":"both","billing_class":"facility"}]},{"description":"BCR/ABL P210  ZB3RV","code_information":[{"code":"15108","type":"CDM"},{"code":"300","type":"RC"},{"code":"81206","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":529.3,"discounted_cash":264.65,"setting":"both","billing_class":"facility"}]},{"description":"ELECTROLYTE PANEL","code_information":[{"code":"15109","type":"CDM"},{"code":"300","type":"RC"},{"code":"80051","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.8,"discounted_cash":39.4,"setting":"both","billing_class":"facility"}]},{"description":"COMP METABOLIC PANEL","code_information":[{"code":"15110","type":"CDM"},{"code":"300","type":"RC"},{"code":"80053","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":111.5,"setting":"both","billing_class":"facility"}]},{"description":"OB PANEL W/BB ID","code_information":[{"code":"15113","type":"CDM"},{"code":"300","type":"RC"},{"code":"80055","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.5,"discounted_cash":75.75,"setting":"both","billing_class":"facility"}]},{"description":"OBSTETRIC PANEL","code_information":[{"code":"15114","type":"CDM"},{"code":"300","type":"RC"},{"code":"80081","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":309.65,"discounted_cash":154.82,"setting":"both","billing_class":"facility"}]},{"description":"HEPATIC FUNCT PANEL","code_information":[{"code":"15116","type":"CDM"},{"code":"300","type":"RC"},{"code":"80076","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":144.2,"discounted_cash":72.1,"setting":"both","billing_class":"facility"}]},{"description":"ACUTE HEP PANEL","code_information":[{"code":"15117","type":"CDM"},{"code":"301","type":"RC"},{"code":"80074","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":368.45,"discounted_cash":184.22,"setting":"both","billing_class":"facility"}]},{"description":"LIPID PANEL","code_information":[{"code":"15118","type":"CDM"},{"code":"300","type":"RC"},{"code":"80061","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.55,"discounted_cash":38.77,"setting":"both","billing_class":"facility"}]},{"description":"CARDIO IQ ADV. LIPID","code_information":[{"code":"15120","type":"CDM"},{"code":"300","type":"RC"},{"code":"80061","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":153.95,"discounted_cash":76.97,"setting":"both","billing_class":"facility"}]},{"description":"RENAL FUNCTION PANEL","code_information":[{"code":"15121","type":"CDM"},{"code":"300","type":"RC"},{"code":"80069","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":180.6,"discounted_cash":90.3,"setting":"both","billing_class":"facility"}]},{"description":"URINE DRUG SCRN W CO","code_information":[{"code":"15149","type":"CDM"},{"code":"300","type":"RC"},{"code":"80305","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":147.85,"discounted_cash":73.92,"setting":"both","billing_class":"facility"}]},{"description":"DRUG SCREEN URINE","code_information":[{"code":"15152","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":145.4,"discounted_cash":72.7,"setting":"both","billing_class":"facility"}]},{"description":"DRUG SCREEN BLOOD","code_information":[{"code":"15153","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":128.75,"setting":"both","billing_class":"facility"}]},{"description":"IA MULT NONINF AB/AG","code_information":[{"code":"15163","type":"CDM"},{"code":"301","type":"RC"},{"code":"83516","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.7,"discounted_cash":36.35,"setting":"both","billing_class":"facility"}]},{"description":"IA-2 ANTIBODY","code_information":[{"code":"15166","type":"CDM"},{"code":"300","type":"RC"},{"code":"86341","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":233.3,"discounted_cash":116.65,"setting":"both","billing_class":"facility"}]},{"description":"OXYCODONE CONFIRM","code_information":[{"code":"15178","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":152.7,"discounted_cash":76.35,"setting":"both","billing_class":"facility"}]},{"description":"MOG-IGG1 ANTB CBA EA","code_information":[{"code":"15179","type":"CDM"},{"code":"302","type":"RC"},{"code":"86362","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.6,"discounted_cash":28.8,"setting":"both","billing_class":"facility"}]},{"description":"VOLTAGE-GTD CA CHNL","code_information":[{"code":"15180","type":"CDM"},{"code":"302","type":"RC"},{"code":"86596","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.2,"discounted_cash":44.1,"setting":"both","billing_class":"facility"}]},{"description":"AMINO ACIDS SINGLE Q","code_information":[{"code":"15181","type":"CDM"},{"code":"301","type":"RC"},{"code":"82131","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.55,"discounted_cash":51.27,"setting":"both","billing_class":"facility"}]},{"description":"DGP ANTIBODY EACH IG","code_information":[{"code":"15182","type":"CDM"},{"code":"302","type":"RC"},{"code":"86258","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.1,"discounted_cash":27.55,"setting":"both","billing_class":"facility"}]},{"description":"ASSAY OF HALOPERIDOL","code_information":[{"code":"15183","type":"CDM"},{"code":"301","type":"RC"},{"code":"80173","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.5,"discounted_cash":37.75,"setting":"both","billing_class":"facility"}]},{"description":"QUANTITAT ASSAY DRUG","code_information":[{"code":"15184","type":"CDM"},{"code":"301","type":"RC"},{"code":"80299","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":89.3,"discounted_cash":44.65,"setting":"both","billing_class":"facility"}]},{"description":"DIPROPYLACETIC ACID","code_information":[{"code":"15185","type":"CDM"},{"code":"301","type":"RC"},{"code":"80165","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.8,"discounted_cash":32.4,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL URINE QUAL","code_information":[{"code":"15187","type":"CDM"},{"code":"301","type":"RC"},{"code":"80307","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.7,"discounted_cash":36.35,"setting":"both","billing_class":"facility"}]},{"description":"COL CHROMOTOGRAPHY Q","code_information":[{"code":"15188","type":"CDM"},{"code":"301","type":"RC"},{"code":"82542","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.45,"discounted_cash":53.73,"setting":"both","billing_class":"facility"}]},{"description":"FLUORESCENT ANTIBODY","code_information":[{"code":"15189","type":"CDM"},{"code":"302","type":"RC"},{"code":"86255","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.6,"discounted_cash":28.8,"setting":"both","billing_class":"facility"}]},{"description":"MOPATH PROCEDURE 7","code_information":[{"code":"15190","type":"CDM"},{"code":"310","type":"RC"},{"code":"81406","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":992.75,"discounted_cash":496.38,"setting":"both","billing_class":"facility"}]},{"description":"NUCLEAR ANTIGEN ANTI","code_information":[{"code":"15192","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":85.75,"discounted_cash":42.88,"setting":"both","billing_class":"facility"}]},{"description":"ASAY INTERLEUKIN-6","code_information":[{"code":"15194","type":"CDM"},{"code":"301","type":"RC"},{"code":"83529","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.7,"discounted_cash":41.35,"setting":"both","billing_class":"facility"}]},{"description":"VOLTAGE-GTD CA CHNL","code_information":[{"code":"15195","type":"CDM"},{"code":"302","type":"RC"},{"code":"86596","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.2,"discounted_cash":44.1,"setting":"both","billing_class":"facility"}]},{"description":"AMPHETAMINES 5 OR +","code_information":[{"code":"15197","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"ANALGESIC NON-OPIOID","code_information":[{"code":"15198","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"ANTIDEPRESSANT CLASS","code_information":[{"code":"15199","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"TRICYCLIC & CYCLICAL","code_information":[{"code":"15200","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"ANTIDEPRESANT UNSPEC","code_information":[{"code":"15202","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"ANTIEPILEPTICS NOS 7","code_information":[{"code":"15203","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"ANTIPSYCHOTICS NOS 7","code_information":[{"code":"15204","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"BENZODIAZEPINES 13 +","code_information":[{"code":"15205","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0481","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":599.5,"discounted_cash":299.75,"setting":"both","billing_class":"facility"}]},{"description":"DRUG SCRN BUPRENORPH","code_information":[{"code":"15207","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"GABAPENTIN NON-BLOOD","code_information":[{"code":"15208","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"KETAMINE AND NORKETA","code_information":[{"code":"15209","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPHENIDATE","code_information":[{"code":"15210","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"OPIOID OPIATE ANALOG","code_information":[{"code":"15212","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"DRUG SCRN OXYCODONE","code_information":[{"code":"15213","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"DRUG SCRN PREGABALIN","code_information":[{"code":"15214","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"SEDATIVE HYPNOTICS","code_information":[{"code":"15215","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"STIMULANTS SYNTHETIC","code_information":[{"code":"15217","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"DRUG/SUBSTANCE NOS 7","code_information":[{"code":"15218","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"DRUG SCRN TAPENTADOL","code_information":[{"code":"15219","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"DRUG SCRN PROPOXYPHE","code_information":[{"code":"15220","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"SKEL MUSC RELAXANT 3","code_information":[{"code":"15222","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"URINE DRUG S OR M","code_information":[{"code":"15229","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":115.15,"discounted_cash":57.58,"setting":"both","billing_class":"facility"}]},{"description":"AMIKACIN PEAK","code_information":[{"code":"15233","type":"CDM"},{"code":"300","type":"RC"},{"code":"80150","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.9,"discounted_cash":53.95,"setting":"both","billing_class":"facility"}]},{"description":"AMIKACIN TROUGH","code_information":[{"code":"15234","type":"CDM"},{"code":"300","type":"RC"},{"code":"80150","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.9,"discounted_cash":53.95,"setting":"both","billing_class":"facility"}]},{"description":"BENZODIAZEPINES","code_information":[{"code":"15238","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":115.15,"discounted_cash":57.58,"setting":"both","billing_class":"facility"}]},{"description":"CARBAMAZEPINE TOT","code_information":[{"code":"15239","type":"CDM"},{"code":"300","type":"RC"},{"code":"80156","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.7,"discounted_cash":36.35,"setting":"both","billing_class":"facility"}]},{"description":"CARBAMAZEPINE FREE","code_information":[{"code":"15240","type":"CDM"},{"code":"300","type":"RC"},{"code":"80157","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.8,"discounted_cash":39.4,"setting":"both","billing_class":"facility"}]},{"description":"CYCLOSPORINE","code_information":[{"code":"15241","type":"CDM"},{"code":"300","type":"RC"},{"code":"80158","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.2,"discounted_cash":52.1,"setting":"both","billing_class":"facility"}]},{"description":"DESIPRAMNE","code_information":[{"code":"15242","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.05,"discounted_cash":151.53,"setting":"both","billing_class":"facility"}]},{"description":"DIGOXIN","code_information":[{"code":"15243","type":"CDM"},{"code":"300","type":"RC"},{"code":"80162","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.6,"discounted_cash":53.3,"setting":"both","billing_class":"facility"}]},{"description":"VALPROIC ACID","code_information":[{"code":"15244","type":"CDM"},{"code":"300","type":"RC"},{"code":"80164","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.9,"discounted_cash":36.95,"setting":"both","billing_class":"facility"}]},{"description":"ETHOSUXIMIDE","code_information":[{"code":"15246","type":"CDM"},{"code":"300","type":"RC"},{"code":"80168","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.8,"discounted_cash":30.9,"setting":"both","billing_class":"facility"}]},{"description":"GENTAMICIN","code_information":[{"code":"15247","type":"CDM"},{"code":"300","type":"RC"},{"code":"80170","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.2,"discounted_cash":52.1,"setting":"both","billing_class":"facility"}]},{"description":"GENTAMICIN TROUGH","code_information":[{"code":"15248","type":"CDM"},{"code":"300","type":"RC"},{"code":"80170","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.2,"discounted_cash":52.1,"setting":"both","billing_class":"facility"}]},{"description":"GENTAMICIN PEAK","code_information":[{"code":"15249","type":"CDM"},{"code":"300","type":"RC"},{"code":"80170","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.2,"discounted_cash":52.1,"setting":"both","billing_class":"facility"}]},{"description":"LITHIUM","code_information":[{"code":"15252","type":"CDM"},{"code":"300","type":"RC"},{"code":"80178","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.4,"discounted_cash":32.7,"setting":"both","billing_class":"facility"}]},{"description":"NORTRIPTYLINE","code_information":[{"code":"15253","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":212.1,"discounted_cash":106.05,"setting":"both","billing_class":"facility"}]},{"description":"PHENOBARBITAL","code_information":[{"code":"15254","type":"CDM"},{"code":"300","type":"RC"},{"code":"80184","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":35.15,"setting":"both","billing_class":"facility"}]},{"description":"PHENYTOIN TOTAL","code_information":[{"code":"15255","type":"CDM"},{"code":"300","type":"RC"},{"code":"80185","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":35.15,"setting":"both","billing_class":"facility"}]},{"description":"PRIMIDONE","code_information":[{"code":"15256","type":"CDM"},{"code":"300","type":"RC"},{"code":"80188","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.65,"discounted_cash":41.83,"setting":"both","billing_class":"facility"}]},{"description":"SIROLIMUS","code_information":[{"code":"15261","type":"CDM"},{"code":"300","type":"RC"},{"code":"80195","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.05,"discounted_cash":43.02,"setting":"both","billing_class":"facility"}]},{"description":"SIALIDASE ENZYME ASS","code_information":[{"code":"15262","type":"CDM"},{"code":"306","type":"RC"},{"code":"87905","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.45,"discounted_cash":29.23,"setting":"both","billing_class":"facility"}]},{"description":"SALICYLATES","code_information":[{"code":"15263","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":181.8,"discounted_cash":90.9,"setting":"both","billing_class":"facility"}]},{"description":"TACROLIMUS","code_information":[{"code":"15264","type":"CDM"},{"code":"300","type":"RC"},{"code":"80197","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.75,"discounted_cash":79.38,"setting":"both","billing_class":"facility"}]},{"description":"THEOPHYLLINE","code_information":[{"code":"15266","type":"CDM"},{"code":"300","type":"RC"},{"code":"80198","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":81.2,"discounted_cash":40.6,"setting":"both","billing_class":"facility"}]},{"description":"TOBRAMYCIN","code_information":[{"code":"15267","type":"CDM"},{"code":"300","type":"RC"},{"code":"80200","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":144.2,"discounted_cash":72.1,"setting":"both","billing_class":"facility"}]},{"description":"TOBRAMYCIN TROUGH","code_information":[{"code":"15268","type":"CDM"},{"code":"300","type":"RC"},{"code":"80200","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":144.2,"discounted_cash":72.1,"setting":"both","billing_class":"facility"}]},{"description":"TOBRAMYCIN PEAK","code_information":[{"code":"15269","type":"CDM"},{"code":"300","type":"RC"},{"code":"80200","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.9,"discounted_cash":53.95,"setting":"both","billing_class":"facility"}]},{"description":"DRUG ASSAY CLOZAPINE","code_information":[{"code":"15270","type":"CDM"},{"code":"301","type":"RC"},{"code":"80159","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":89.7,"discounted_cash":44.85,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN","code_information":[{"code":"15271","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.9,"discounted_cash":36.95,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN TROUGH","code_information":[{"code":"15272","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.9,"discounted_cash":36.95,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN PEAK","code_information":[{"code":"15273","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.9,"discounted_cash":36.95,"setting":"both","billing_class":"facility"}]},{"description":"PROTEINASE 3 AB","code_information":[{"code":"15276","type":"CDM"},{"code":"300","type":"RC"},{"code":"86021","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":71.95,"discounted_cash":35.98,"setting":"both","billing_class":"facility"}]},{"description":"ALLOPURNOL+ METABOLT","code_information":[{"code":"15279","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":174.5,"discounted_cash":87.25,"setting":"both","billing_class":"facility"}]},{"description":"LEVETIRACETAM LEVEL","code_information":[{"code":"15281","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":193.95,"discounted_cash":96.97,"setting":"both","billing_class":"facility"}]},{"description":"GABAPENTIN","code_information":[{"code":"15285","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":193.95,"discounted_cash":96.97,"setting":"both","billing_class":"facility"}]},{"description":"LAMOTRIGINE","code_information":[{"code":"15290","type":"CDM"},{"code":"300","type":"RC"},{"code":"80175","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":193.95,"discounted_cash":96.97,"setting":"both","billing_class":"facility"}]},{"description":"METHOTREXATE","code_information":[{"code":"15291","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.35,"discounted_cash":29.68,"setting":"both","billing_class":"facility"}]},{"description":"DISOPYRAMIDE (NORPAC","code_information":[{"code":"15295","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":238.75,"discounted_cash":119.38,"setting":"both","billing_class":"facility"}]},{"description":"EVEROLIMUS BLD","code_information":[{"code":"15296","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.9,"discounted_cash":53.95,"setting":"both","billing_class":"facility"}]},{"description":"TRILEPTAL","code_information":[{"code":"15306","type":"CDM"},{"code":"300","type":"RC"},{"code":"80183","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":193.6,"discounted_cash":96.8,"setting":"both","billing_class":"facility"}]},{"description":"UA AUTO W MICRO","code_information":[{"code":"15329","type":"CDM"},{"code":"300","type":"RC"},{"code":"81001","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.3,"discounted_cash":20.65,"setting":"both","billing_class":"facility"}]},{"description":"INFLUENZA A AG","code_information":[{"code":"15335","type":"CDM"},{"code":"300","type":"RC"},{"code":"87400","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.65,"discounted_cash":35.33,"setting":"both","billing_class":"facility"}]},{"description":"INFLUENZA B AG","code_information":[{"code":"15336","type":"CDM"},{"code":"300","type":"RC"},{"code":"87400","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.65,"discounted_cash":35.33,"setting":"both","billing_class":"facility"}]},{"description":"URINE DIPSTICK","code_information":[{"code":"15339","type":"CDM"},{"code":"300","type":"RC"},{"code":"81002","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.05,"discounted_cash":24.02,"setting":"both","billing_class":"facility"}]},{"description":"OVA1 INCLUDES FSH LH","code_information":[{"code":"15346","type":"CDM"},{"code":"300","type":"RC"},{"code":"81503","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1368.35,"discounted_cash":684.17,"setting":"both","billing_class":"facility"}]},{"description":"URINALYSIS AUTO WO M","code_information":[{"code":"15347","type":"CDM"},{"code":"300","type":"RC"},{"code":"81003","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility"}]},{"description":"URINE HCG","code_information":[{"code":"15357","type":"CDM"},{"code":"300","type":"RC"},{"code":"81025","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":97.3,"discounted_cash":48.65,"setting":"both","billing_class":"facility"}]},{"description":"URN VOL MSR TIME COL","code_information":[{"code":"15358","type":"CDM"},{"code":"300","type":"RC"},{"code":"81050","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":8.25,"setting":"both","billing_class":"facility"}]},{"description":"ACETAMINOPHEN","code_information":[{"code":"15361","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":163.65,"discounted_cash":81.83,"setting":"both","billing_class":"facility"}]},{"description":"ACETONE QUAL","code_information":[{"code":"15362","type":"CDM"},{"code":"300","type":"RC"},{"code":"82009","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.1,"discounted_cash":14.55,"setting":"both","billing_class":"facility"}]},{"description":"B KETONE","code_information":[{"code":"15365","type":"CDM"},{"code":"300","type":"RC"},{"code":"82010","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.8,"discounted_cash":19.4,"setting":"both","billing_class":"facility"}]},{"description":"ACTH, PLASMA (RIA)","code_information":[{"code":"15367","type":"CDM"},{"code":"300","type":"RC"},{"code":"82024","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":213.3,"discounted_cash":106.65,"setting":"both","billing_class":"facility"}]},{"description":"ALBUMIN, SERUM","code_information":[{"code":"15368","type":"CDM"},{"code":"300","type":"RC"},{"code":"82040","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":13.32,"setting":"both","billing_class":"facility"}]},{"description":"ALBUMIN BODY FLUID","code_information":[{"code":"15370","type":"CDM"},{"code":"300","type":"RC"},{"code":"82042","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":13.32,"setting":"both","billing_class":"facility"}]},{"description":"MICROALBUMN QUANT UA","code_information":[{"code":"15371","type":"CDM"},{"code":"300","type":"RC"},{"code":"82043","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.05,"discounted_cash":23.02,"setting":"both","billing_class":"facility"}]},{"description":"ALCOHOL BLOOD","code_information":[{"code":"15374","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.2,"discounted_cash":112.1,"setting":"both","billing_class":"facility"}]},{"description":"ALCOHOL BREATH","code_information":[{"code":"15376","type":"CDM"},{"code":"300","type":"RC"},{"code":"82075","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.6,"discounted_cash":28.8,"setting":"both","billing_class":"facility"}]},{"description":"ALDOLASE","code_information":[{"code":"15378","type":"CDM"},{"code":"300","type":"RC"},{"code":"82085","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.35,"discounted_cash":44.17,"setting":"both","billing_class":"facility"}]},{"description":"ALDOSTERONE","code_information":[{"code":"15379","type":"CDM"},{"code":"300","type":"RC"},{"code":"82088","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":242.75,"discounted_cash":121.38,"setting":"both","billing_class":"facility"}]},{"description":"ALPHA-1-ANTITRYP TOT","code_information":[{"code":"15380","type":"CDM"},{"code":"300","type":"RC"},{"code":"82103","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.4,"discounted_cash":101.2,"setting":"both","billing_class":"facility"}]},{"description":"A1 ANTITRYPSIN PHENO","code_information":[{"code":"15381","type":"CDM"},{"code":"300","type":"RC"},{"code":"82104","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.6,"discounted_cash":30.3,"setting":"both","billing_class":"facility"}]},{"description":"ALPHA-FETOPROT SER","code_information":[{"code":"15382","type":"CDM"},{"code":"300","type":"RC"},{"code":"82105","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.3,"discounted_cash":55.15,"setting":"both","billing_class":"facility"}]},{"description":"AFP AND AFP- L3","code_information":[{"code":"15384","type":"CDM"},{"code":"300","type":"RC"},{"code":"82107","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.2,"discounted_cash":112.1,"setting":"both","billing_class":"facility"}]},{"description":"ALUMNUM","code_information":[{"code":"15385","type":"CDM"},{"code":"300","type":"RC"},{"code":"82108","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":127.1,"discounted_cash":63.55,"setting":"both","billing_class":"facility"}]},{"description":"URINE CYSTINE QUANT","code_information":[{"code":"15391","type":"CDM"},{"code":"300","type":"RC"},{"code":"82131","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":168.45,"discounted_cash":84.22,"setting":"both","billing_class":"facility"}]},{"description":"HOMOCYSTINE QUANT","code_information":[{"code":"15392","type":"CDM"},{"code":"300","type":"RC"},{"code":"83090","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":186.65,"discounted_cash":93.33,"setting":"both","billing_class":"facility"}]},{"description":"ALA","code_information":[{"code":"15393","type":"CDM"},{"code":"300","type":"RC"},{"code":"82135","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.1,"discounted_cash":38.05,"setting":"both","billing_class":"facility"}]},{"description":"DELTA AMINLVULNC ACD","code_information":[{"code":"15394","type":"CDM"},{"code":"300","type":"RC"},{"code":"82135","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.85,"discounted_cash":25.43,"setting":"both","billing_class":"facility"}]},{"description":"AMINO ACIDS 6> QUAN","code_information":[{"code":"15396","type":"CDM"},{"code":"300","type":"RC"},{"code":"82139","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.05,"discounted_cash":151.53,"setting":"both","billing_class":"facility"}]},{"description":"AMMONIA","code_information":[{"code":"15397","type":"CDM"},{"code":"300","type":"RC"},{"code":"82140","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.4,"discounted_cash":41.2,"setting":"both","billing_class":"facility"}]},{"description":"AMYLASE","code_information":[{"code":"15398","type":"CDM"},{"code":"300","type":"RC"},{"code":"82150","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":35.15,"setting":"both","billing_class":"facility"}]},{"description":"URINE AMYLASE","code_information":[{"code":"15399","type":"CDM"},{"code":"300","type":"RC"},{"code":"82150","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.8,"discounted_cash":39.4,"setting":"both","billing_class":"facility"}]},{"description":"AMYLASE BODY FLUID","code_information":[{"code":"15402","type":"CDM"},{"code":"300","type":"RC"},{"code":"82150","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":12.13,"setting":"both","billing_class":"facility"}]},{"description":"ANDROSTENDIONE","code_information":[{"code":"15403","type":"CDM"},{"code":"300","type":"RC"},{"code":"82157","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility"}]},{"description":"ANGIOTNSIN I CONVRT","code_information":[{"code":"15406","type":"CDM"},{"code":"300","type":"RC"},{"code":"82164","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.85,"discounted_cash":42.42,"setting":"both","billing_class":"facility"}]},{"description":"APOLIPOPROTEIN   EA","code_information":[{"code":"15407","type":"CDM"},{"code":"300","type":"RC"},{"code":"82172","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":99.4,"discounted_cash":49.7,"setting":"both","billing_class":"facility"}]},{"description":"ARSENIC","code_information":[{"code":"15408","type":"CDM"},{"code":"300","type":"RC"},{"code":"82175","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":181.8,"discounted_cash":90.9,"setting":"both","billing_class":"facility"}]},{"description":"ASCORBIC ACID","code_information":[{"code":"15409","type":"CDM"},{"code":"300","type":"RC"},{"code":"82180","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.8,"discounted_cash":39.4,"setting":"both","billing_class":"facility"}]},{"description":"VITAMIN C","code_information":[{"code":"15410","type":"CDM"},{"code":"301","type":"RC"},{"code":"82180","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":44.85,"discounted_cash":22.43,"setting":"both","billing_class":"facility"}]},{"description":"BARBITURT CONF URINE","code_information":[{"code":"15412","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":193.95,"discounted_cash":96.97,"setting":"both","billing_class":"facility"}]},{"description":"BETA 2 PROTEIN","code_information":[{"code":"15414","type":"CDM"},{"code":"300","type":"RC"},{"code":"82232","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.15,"discounted_cash":29.07,"setting":"both","billing_class":"facility"}]},{"description":"14.3.3 ETA PROTEIN","code_information":[{"code":"15415","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.95,"discounted_cash":128.47,"setting":"both","billing_class":"facility"}]},{"description":"BILIRUBIN TOTAL","code_information":[{"code":"15417","type":"CDM"},{"code":"300","type":"RC"},{"code":"82247","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":12.13,"setting":"both","billing_class":"facility"}]},{"description":"BILIRUBIN DIRECT","code_information":[{"code":"15420","type":"CDM"},{"code":"300","type":"RC"},{"code":"82248","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.05,"discounted_cash":23.02,"setting":"both","billing_class":"facility"}]},{"description":"OCC BLOOD FECES","code_information":[{"code":"15422","type":"CDM"},{"code":"300","type":"RC"},{"code":"82270","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.6,"discounted_cash":18.8,"setting":"both","billing_class":"facility"}]},{"description":"OCC BLOOD SCRN OTH","code_information":[{"code":"15423","type":"CDM"},{"code":"300","type":"RC"},{"code":"82271","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":12.13,"setting":"both","billing_class":"facility"}]},{"description":"OCCULT BLD 1-3 TESTS","code_information":[{"code":"15424","type":"CDM"},{"code":"300","type":"RC"},{"code":"82272","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.65,"discounted_cash":41.83,"setting":"both","billing_class":"facility"}]},{"description":"VITAMN D-3 (25 -OH)","code_information":[{"code":"15425","type":"CDM"},{"code":"301","type":"RC"},{"code":"82306","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":132.05,"discounted_cash":66.03,"setting":"both","billing_class":"facility"}]},{"description":"VIT D; 25 HYDROXY","code_information":[{"code":"15426","type":"CDM"},{"code":"300","type":"RC"},{"code":"82306","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":169.7,"discounted_cash":84.85,"setting":"both","billing_class":"facility"}]},{"description":"CALCITONIN","code_information":[{"code":"15427","type":"CDM"},{"code":"300","type":"RC"},{"code":"82308","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.2,"discounted_cash":112.1,"setting":"both","billing_class":"facility"}]},{"description":"CALCIUM","code_information":[{"code":"15428","type":"CDM"},{"code":"300","type":"RC"},{"code":"82310","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.9,"discounted_cash":16.95,"setting":"both","billing_class":"facility"}]},{"description":"CALCIUM IONIZED","code_information":[{"code":"15430","type":"CDM"},{"code":"300","type":"RC"},{"code":"82330","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.9,"discounted_cash":36.95,"setting":"both","billing_class":"facility"}]},{"description":"CALCIUM UA QUANT","code_information":[{"code":"15431","type":"CDM"},{"code":"300","type":"RC"},{"code":"82340","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.35,"discounted_cash":26.68,"setting":"both","billing_class":"facility"}]},{"description":"CALCIUM RANDOM URINE","code_information":[{"code":"15432","type":"CDM"},{"code":"300","type":"RC"},{"code":"82310","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.9,"discounted_cash":16.95,"setting":"both","billing_class":"facility"}]},{"description":"CALCULUS QUAL","code_information":[{"code":"15433","type":"CDM"},{"code":"300","type":"RC"},{"code":"82355","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":180.6,"discounted_cash":90.3,"setting":"both","billing_class":"facility"}]},{"description":"CALCULUS QUANT","code_information":[{"code":"15434","type":"CDM"},{"code":"301","type":"RC"},{"code":"82360","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.55,"discounted_cash":30.77,"setting":"both","billing_class":"facility"}]},{"description":"CALC(STNE) SPCTRSCPY","code_information":[{"code":"15435","type":"CDM"},{"code":"301","type":"RC"},{"code":"82365","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.45,"discounted_cash":30.73,"setting":"both","billing_class":"facility"}]},{"description":"CARBON DIOXIDE","code_information":[{"code":"15437","type":"CDM"},{"code":"300","type":"RC"},{"code":"82374","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility"}]},{"description":"CARBON MONOXIDE QUAN","code_information":[{"code":"15438","type":"CDM"},{"code":"300","type":"RC"},{"code":"82375","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.35,"discounted_cash":29.68,"setting":"both","billing_class":"facility"}]},{"description":"CEA","code_information":[{"code":"15439","type":"CDM"},{"code":"300","type":"RC"},{"code":"82378","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":129.65,"discounted_cash":64.83,"setting":"both","billing_class":"facility"}]},{"description":"CARNITINE/TOTAL&FREE","code_information":[{"code":"15440","type":"CDM"},{"code":"300","type":"RC"},{"code":"82379","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":90.85,"discounted_cash":45.42,"setting":"both","billing_class":"facility"}]},{"description":"CAROTENE","code_information":[{"code":"15441","type":"CDM"},{"code":"300","type":"RC"},{"code":"82380","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":23.0,"setting":"both","billing_class":"facility"}]},{"description":"CATECHOLAMNES TOTAL","code_information":[{"code":"15442","type":"CDM"},{"code":"300","type":"RC"},{"code":"82382","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":267.85,"discounted_cash":133.93,"setting":"both","billing_class":"facility"}]},{"description":"CATECHOLAMINES FRACT","code_information":[{"code":"15444","type":"CDM"},{"code":"300","type":"RC"},{"code":"82384","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":233.9,"discounted_cash":116.95,"setting":"both","billing_class":"facility"}]},{"description":"CERULOPLASMN","code_information":[{"code":"15446","type":"CDM"},{"code":"300","type":"RC"},{"code":"82390","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.55,"discounted_cash":26.77,"setting":"both","billing_class":"facility"}]},{"description":"CHLORIDE BLOOD","code_information":[{"code":"15447","type":"CDM"},{"code":"300","type":"RC"},{"code":"82435","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.45,"discounted_cash":12.72,"setting":"both","billing_class":"facility"}]},{"description":"URINE CHLORIDE","code_information":[{"code":"15449","type":"CDM"},{"code":"300","type":"RC"},{"code":"82436","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":21.2,"setting":"both","billing_class":"facility"}]},{"description":"CHLORIDE 24HR UR","code_information":[{"code":"15450","type":"CDM"},{"code":"300","type":"RC"},{"code":"82436","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.1,"discounted_cash":12.55,"setting":"both","billing_class":"facility"}]},{"description":"CHLORIDE OTHR SOURCE","code_information":[{"code":"15451","type":"CDM"},{"code":"301","type":"RC"},{"code":"82438","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.35,"discounted_cash":13.18,"setting":"both","billing_class":"facility"}]},{"description":"CHOLESTEROL, SERUM","code_information":[{"code":"15453","type":"CDM"},{"code":"300","type":"RC"},{"code":"82465","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.45,"discounted_cash":12.72,"setting":"both","billing_class":"facility"}]},{"description":"ITRACONAZOLE LEVEL","code_information":[{"code":"15473","type":"CDM"},{"code":"301","type":"RC"},{"code":"82542","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.6,"discounted_cash":53.8,"setting":"both","billing_class":"facility"}]},{"description":"CITRATE","code_information":[{"code":"15480","type":"CDM"},{"code":"300","type":"RC"},{"code":"82507","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.7,"discounted_cash":69.35,"setting":"both","billing_class":"facility"}]},{"description":"COCAINE QUANT","code_information":[{"code":"15482","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":90.85,"discounted_cash":45.42,"setting":"both","billing_class":"facility"}]},{"description":"COPPER","code_information":[{"code":"15483","type":"CDM"},{"code":"300","type":"RC"},{"code":"82525","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.85,"discounted_cash":30.93,"setting":"both","billing_class":"facility"}]},{"description":"CORTISOL FREE","code_information":[{"code":"15485","type":"CDM"},{"code":"300","type":"RC"},{"code":"82530","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":98.15,"discounted_cash":49.08,"setting":"both","billing_class":"facility"}]},{"description":"CORTISOL TOTAL","code_information":[{"code":"15486","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":98.15,"discounted_cash":49.08,"setting":"both","billing_class":"facility"}]},{"description":"THC CONFIRMATION QT","code_information":[{"code":"15490","type":"CDM"},{"code":"300","type":"RC"},{"code":"82542","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.05,"discounted_cash":63.02,"setting":"both","billing_class":"facility"}]},{"description":"CPK","code_information":[{"code":"15492","type":"CDM"},{"code":"300","type":"RC"},{"code":"82550","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.8,"discounted_cash":19.4,"setting":"both","billing_class":"facility"}]},{"description":"CPK ISOENZYMES","code_information":[{"code":"15493","type":"CDM"},{"code":"300","type":"RC"},{"code":"82552","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.4,"discounted_cash":41.2,"setting":"both","billing_class":"facility"}]},{"description":"CKMB","code_information":[{"code":"15494","type":"CDM"},{"code":"300","type":"RC"},{"code":"82553","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.4,"discounted_cash":41.2,"setting":"both","billing_class":"facility"}]},{"description":"CREATININE BLOOD","code_information":[{"code":"15495","type":"CDM"},{"code":"300","type":"RC"},{"code":"82565","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.1,"discounted_cash":14.55,"setting":"both","billing_class":"facility"}]},{"description":"CREATININE 24HR UR","code_information":[{"code":"15497","type":"CDM"},{"code":"301","type":"RC"},{"code":"82570","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":13.25,"setting":"both","billing_class":"facility"}]},{"description":"CREATININE URINE","code_information":[{"code":"15498","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":44.85,"discounted_cash":22.43,"setting":"both","billing_class":"facility"}]},{"description":"CREATININE CLEARANCE","code_information":[{"code":"15500","type":"CDM"},{"code":"300","type":"RC"},{"code":"82575","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.55,"discounted_cash":38.77,"setting":"both","billing_class":"facility"}]},{"description":"CRYOGLOBULIN","code_information":[{"code":"15501","type":"CDM"},{"code":"300","type":"RC"},{"code":"82595","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.8,"discounted_cash":19.4,"setting":"both","billing_class":"facility"}]},{"description":"CRYO SCRN/REFLX PRFL","code_information":[{"code":"15502","type":"CDM"},{"code":"301","type":"RC"},{"code":"82595","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":16.13,"setting":"both","billing_class":"facility"}]},{"description":"VITAMN B-12","code_information":[{"code":"15504","type":"CDM"},{"code":"300","type":"RC"},{"code":"82607","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.3,"discounted_cash":55.15,"setting":"both","billing_class":"facility"}]},{"description":"CYSTATIN C","code_information":[{"code":"15505","type":"CDM"},{"code":"300","type":"RC"},{"code":"82610","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.9,"discounted_cash":36.95,"setting":"both","billing_class":"facility"}]},{"description":"DHEA","code_information":[{"code":"15506","type":"CDM"},{"code":"300","type":"RC"},{"code":"82626","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.05,"discounted_cash":63.02,"setting":"both","billing_class":"facility"}]},{"description":"DHEA SULFATE","code_information":[{"code":"15507","type":"CDM"},{"code":"300","type":"RC"},{"code":"82627","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.9,"discounted_cash":55.45,"setting":"both","billing_class":"facility"}]},{"description":"DIHYDROCODEINONE","code_information":[{"code":"15508","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.2,"discounted_cash":112.1,"setting":"both","billing_class":"facility"}]},{"description":"DIHYDROXYVIT D 1,25","code_information":[{"code":"15509","type":"CDM"},{"code":"300","type":"RC"},{"code":"82652","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.95,"discounted_cash":88.47,"setting":"both","billing_class":"facility"}]},{"description":"DIHYDROTESTOSTERONE","code_information":[{"code":"15510","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.2,"discounted_cash":112.1,"setting":"both","billing_class":"facility"}]},{"description":"PANCREATIC ELASTASE","code_information":[{"code":"15511","type":"CDM"},{"code":"300","type":"RC"},{"code":"82656","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.95,"discounted_cash":48.48,"setting":"both","billing_class":"facility"}]},{"description":"PANCREATC POLYPEPTID","code_information":[{"code":"15512","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":367.25,"discounted_cash":183.63,"setting":"both","billing_class":"facility"}]},{"description":"ENZYME ACTIVITY NOS","code_information":[{"code":"15514","type":"CDM"},{"code":"300","type":"RC"},{"code":"82657","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":494.5,"discounted_cash":247.25,"setting":"both","billing_class":"facility"}]},{"description":"ERYTHROPOIETIN","code_information":[{"code":"15516","type":"CDM"},{"code":"300","type":"RC"},{"code":"82668","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":93.7,"discounted_cash":46.85,"setting":"both","billing_class":"facility"}]},{"description":"ESTRADIOL","code_information":[{"code":"15517","type":"CDM"},{"code":"300","type":"RC"},{"code":"82670","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.75,"discounted_cash":79.38,"setting":"both","billing_class":"facility"}]},{"description":"ESTROGENS FRACT","code_information":[{"code":"15518","type":"CDM"},{"code":"300","type":"RC"},{"code":"82671","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":195.15,"discounted_cash":97.58,"setting":"both","billing_class":"facility"}]},{"description":"ESTROGENS TOTAL","code_information":[{"code":"15521","type":"CDM"},{"code":"301","type":"RC"},{"code":"82672","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.65,"discounted_cash":48.33,"setting":"both","billing_class":"facility"}]},{"description":"ESTRIOL","code_information":[{"code":"15522","type":"CDM"},{"code":"300","type":"RC"},{"code":"82677","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.1,"discounted_cash":54.55,"setting":"both","billing_class":"facility"}]},{"description":"FECAL FAT QUAL","code_information":[{"code":"15523","type":"CDM"},{"code":"301","type":"RC"},{"code":"82705","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.05,"discounted_cash":13.03,"setting":"both","billing_class":"facility"}]},{"description":"FECAL FAT QUANT","code_information":[{"code":"15524","type":"CDM"},{"code":"300","type":"RC"},{"code":"82710","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":133.3,"discounted_cash":66.65,"setting":"both","billing_class":"facility"}]},{"description":"FERRITIN","code_information":[{"code":"15526","type":"CDM"},{"code":"300","type":"RC"},{"code":"82728","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.55,"discounted_cash":38.77,"setting":"both","billing_class":"facility"}]},{"description":"FOLIC ACID, SERUM","code_information":[{"code":"15527","type":"CDM"},{"code":"300","type":"RC"},{"code":"82746","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":105.4,"discounted_cash":52.7,"setting":"both","billing_class":"facility"}]},{"description":"FOLIC ACID RBC","code_information":[{"code":"15528","type":"CDM"},{"code":"300","type":"RC"},{"code":"82747","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility"}]},{"description":"IGA  IGD  IGG OR IGM","code_information":[{"code":"15531","type":"CDM"},{"code":"301","type":"RC"},{"code":"82784","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.45,"discounted_cash":44.23,"setting":"both","billing_class":"facility"}]},{"description":"IGE","code_information":[{"code":"15533","type":"CDM"},{"code":"300","type":"RC"},{"code":"82785","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD PH","code_information":[{"code":"15535","type":"CDM"},{"code":"300","type":"RC"},{"code":"82800","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.15,"discounted_cash":26.07,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD GASES","code_information":[{"code":"15536","type":"CDM"},{"code":"300","type":"RC"},{"code":"82803","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.3,"discounted_cash":75.15,"setting":"both","billing_class":"facility"}]},{"description":"GASTRIN","code_information":[{"code":"15538","type":"CDM"},{"code":"300","type":"RC"},{"code":"82941","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":153.95,"discounted_cash":76.97,"setting":"both","billing_class":"facility"}]},{"description":"GLUCOSE BODY FLUID","code_information":[{"code":"15540","type":"CDM"},{"code":"300","type":"RC"},{"code":"82945","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":23.63,"setting":"both","billing_class":"facility"}]},{"description":"GLUCOSE QUANT","code_information":[{"code":"15543","type":"CDM"},{"code":"300","type":"RC"},{"code":"82947","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"GLUCOSE 2HR PP","code_information":[{"code":"15544","type":"CDM"},{"code":"301","type":"RC"},{"code":"82947","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.95,"discounted_cash":9.97,"setting":"both","billing_class":"facility"}]},{"description":"GLUCOSE POST DOSE","code_information":[{"code":"15546","type":"CDM"},{"code":"300","type":"RC"},{"code":"82950","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"GTT UP TO 3 SPEC","code_information":[{"code":"15547","type":"CDM"},{"code":"300","type":"RC"},{"code":"82951","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":60.6,"setting":"both","billing_class":"facility"}]},{"description":"G6PD QUANT","code_information":[{"code":"15554","type":"CDM"},{"code":"300","type":"RC"},{"code":"82955","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.5,"discounted_cash":55.75,"setting":"both","billing_class":"facility"}]},{"description":"GGT","code_information":[{"code":"15555","type":"CDM"},{"code":"300","type":"RC"},{"code":"82977","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"FRUCTOSAMNE","code_information":[{"code":"15556","type":"CDM"},{"code":"300","type":"RC"},{"code":"82985","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.4,"discounted_cash":13.2,"setting":"both","billing_class":"facility"}]},{"description":"ALPH-1-ACID GLYCPRTN","code_information":[{"code":"15557","type":"CDM"},{"code":"300","type":"RC"},{"code":"82985","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":178.2,"discounted_cash":89.1,"setting":"both","billing_class":"facility"}]},{"description":"FSH","code_information":[{"code":"15558","type":"CDM"},{"code":"300","type":"RC"},{"code":"83001","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":92.65,"discounted_cash":46.33,"setting":"both","billing_class":"facility"}]},{"description":"LH","code_information":[{"code":"15559","type":"CDM"},{"code":"300","type":"RC"},{"code":"83002","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":92.35,"discounted_cash":46.17,"setting":"both","billing_class":"facility"}]},{"description":"HGH","code_information":[{"code":"15560","type":"CDM"},{"code":"300","type":"RC"},{"code":"83003","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.15,"discounted_cash":41.58,"setting":"both","billing_class":"facility"}]},{"description":"HAPTOGLOBIN","code_information":[{"code":"15561","type":"CDM"},{"code":"300","type":"RC"},{"code":"83010","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.8,"discounted_cash":39.4,"setting":"both","billing_class":"facility"}]},{"description":"HEMOGLBIN ELECTRO","code_information":[{"code":"15568","type":"CDM"},{"code":"300","type":"RC"},{"code":"83020","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":35.15,"setting":"both","billing_class":"facility"}]},{"description":"HEMOGLOBIN GLYCAT","code_information":[{"code":"15569","type":"CDM"},{"code":"301","type":"RC"},{"code":"83036","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.05,"discounted_cash":43.02,"setting":"both","billing_class":"facility"}]},{"description":"HEMOGLOBIN  PLASMA","code_information":[{"code":"15571","type":"CDM"},{"code":"300","type":"RC"},{"code":"83051","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":89.65,"discounted_cash":44.83,"setting":"both","billing_class":"facility"}]},{"description":"HYDROXYPREGNENOL -17","code_information":[{"code":"15576","type":"CDM"},{"code":"300","type":"RC"},{"code":"84143","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":145.4,"discounted_cash":72.7,"setting":"both","billing_class":"facility"}]},{"description":"HIAA 5","code_information":[{"code":"15578","type":"CDM"},{"code":"300","type":"RC"},{"code":"83497","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":56.95,"discounted_cash":28.48,"setting":"both","billing_class":"facility"}]},{"description":"HYDROXYPROGEST 17D","code_information":[{"code":"15579","type":"CDM"},{"code":"300","type":"RC"},{"code":"83498","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.8,"discounted_cash":39.4,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNOASSAY QT RIA","code_information":[{"code":"15585","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":189.05,"discounted_cash":94.53,"setting":"both","billing_class":"facility"}]},{"description":"THYRTRPIN BIN INH IG","code_information":[{"code":"15595","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":206.05,"discounted_cash":103.03,"setting":"both","billing_class":"facility"}]},{"description":"IMMU ASSAY QT NOS","code_information":[{"code":"15599","type":"CDM"},{"code":"301","type":"RC"},{"code":"83520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":129.65,"discounted_cash":64.83,"setting":"both","billing_class":"facility"}]},{"description":"FETAL LUNG MATURITY","code_information":[{"code":"15600","type":"CDM"},{"code":"300","type":"RC"},{"code":"83664","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.8,"discounted_cash":30.9,"setting":"both","billing_class":"facility"}]},{"description":"GLIADIN ANTIBODY","code_information":[{"code":"15604","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":35.15,"setting":"both","billing_class":"facility"}]},{"description":"BULLOS PEMPHGD AB BP","code_information":[{"code":"15607","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.55,"discounted_cash":32.27,"setting":"both","billing_class":"facility"}]},{"description":"BULLS PEMPHGD IGG BP","code_information":[{"code":"15608","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":156.35,"discounted_cash":78.17,"setting":"both","billing_class":"facility"}]},{"description":"GBM ANTIBODY","code_information":[{"code":"15609","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":89.65,"discounted_cash":44.83,"setting":"both","billing_class":"facility"}]},{"description":"TRANSGLUTAM AB IGA","code_information":[{"code":"15616","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":89.65,"discounted_cash":44.83,"setting":"both","billing_class":"facility"}]},{"description":"MYELOPEROX AUTO AB","code_information":[{"code":"15617","type":"CDM"},{"code":"301","type":"RC"},{"code":"83520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":39.25,"setting":"both","billing_class":"facility"}]},{"description":"INSULIN TOTAL","code_information":[{"code":"15619","type":"CDM"},{"code":"300","type":"RC"},{"code":"83525","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.7,"discounted_cash":36.35,"setting":"both","billing_class":"facility"}]},{"description":"INSULIN FREE","code_information":[{"code":"15620","type":"CDM"},{"code":"300","type":"RC"},{"code":"83527","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.45,"discounted_cash":24.23,"setting":"both","billing_class":"facility"}]},{"description":"IRON","code_information":[{"code":"15621","type":"CDM"},{"code":"300","type":"RC"},{"code":"83540","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.15,"discounted_cash":26.07,"setting":"both","billing_class":"facility"}]},{"description":"IRON LIVER TISSUE","code_information":[{"code":"15623","type":"CDM"},{"code":"300","type":"RC"},{"code":"83540","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":231.5,"setting":"both","billing_class":"facility"}]},{"description":"IRON BINDNG CAPACITY","code_information":[{"code":"15624","type":"CDM"},{"code":"300","type":"RC"},{"code":"83550","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.75,"discounted_cash":27.88,"setting":"both","billing_class":"facility"}]},{"description":"LACTIC ACID","code_information":[{"code":"15627","type":"CDM"},{"code":"300","type":"RC"},{"code":"83605","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.3,"discounted_cash":26.65,"setting":"both","billing_class":"facility"}]},{"description":"LACTATE BODY FLD","code_information":[{"code":"15628","type":"CDM"},{"code":"300","type":"RC"},{"code":"83605","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.3,"discounted_cash":26.65,"setting":"both","billing_class":"facility"}]},{"description":"ENZ DETECT BETA LACT","code_information":[{"code":"15629","type":"CDM"},{"code":"306","type":"RC"},{"code":"87185","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.15,"discounted_cash":9.07,"setting":"both","billing_class":"facility"}]},{"description":"LDH SERUM","code_information":[{"code":"15630","type":"CDM"},{"code":"300","type":"RC"},{"code":"83615","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.05,"discounted_cash":23.02,"setting":"both","billing_class":"facility"}]},{"description":"LDH BODY FLUID","code_information":[{"code":"15631","type":"CDM"},{"code":"300","type":"RC"},{"code":"83615","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.05,"discounted_cash":23.02,"setting":"both","billing_class":"facility"}]},{"description":"ASSAY OF SOMATOSTATI","code_information":[{"code":"15633","type":"CDM"},{"code":"301","type":"RC"},{"code":"84307","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.4,"discounted_cash":43.7,"setting":"both","billing_class":"facility"}]},{"description":"SALMONELLA ANTIBODY","code_information":[{"code":"15634","type":"CDM"},{"code":"302","type":"RC"},{"code":"86768","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility"}]},{"description":"FETAL CHRMOML MICROD","code_information":[{"code":"15635","type":"CDM"},{"code":"300","type":"RC"},{"code":"81422","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2418.4,"discounted_cash":1209.2,"setting":"both","billing_class":"facility"}]},{"description":"ORTHOPOXVIRUS AMP PR","code_information":[{"code":"15636","type":"CDM"},{"code":"306","type":"RC"},{"code":"87593","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":2.5,"setting":"both","billing_class":"facility"}]},{"description":"MICRODISSECTION LASE","code_information":[{"code":"15637","type":"CDM"},{"code":"310","type":"RC"},{"code":"88380","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1413.3,"discounted_cash":706.65,"setting":"both","billing_class":"facility"}]},{"description":"LDH ISOENZYMES","code_information":[{"code":"15638","type":"CDM"},{"code":"300","type":"RC"},{"code":"83625","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility"}]},{"description":"LACTOFERIN FECAL QL","code_information":[{"code":"15640","type":"CDM"},{"code":"300","type":"RC"},{"code":"83630","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.7,"discounted_cash":36.35,"setting":"both","billing_class":"facility"}]},{"description":"LEAD","code_information":[{"code":"15641","type":"CDM"},{"code":"300","type":"RC"},{"code":"83655","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":67.9,"discounted_cash":33.95,"setting":"both","billing_class":"facility"}]},{"description":"FET LNG MAT FL POL","code_information":[{"code":"15645","type":"CDM"},{"code":"300","type":"RC"},{"code":"83663","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.3,"discounted_cash":55.15,"setting":"both","billing_class":"facility"}]},{"description":"LAMELLAR BODY DENS","code_information":[{"code":"15646","type":"CDM"},{"code":"300","type":"RC"},{"code":"83664","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.55,"discounted_cash":27.27,"setting":"both","billing_class":"facility"}]},{"description":"LIPASE","code_information":[{"code":"15647","type":"CDM"},{"code":"300","type":"RC"},{"code":"83690","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":67.9,"discounted_cash":33.95,"setting":"both","billing_class":"facility"}]},{"description":"LIPASE-BODY FLUID","code_information":[{"code":"15648","type":"CDM"},{"code":"300","type":"RC"},{"code":"83690","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.35,"discounted_cash":17.18,"setting":"both","billing_class":"facility"}]},{"description":"LIPOPROTEIN (A) SRM","code_information":[{"code":"15649","type":"CDM"},{"code":"300","type":"RC"},{"code":"83695","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.55,"discounted_cash":32.27,"setting":"both","billing_class":"facility"}]},{"description":"LIPOPROTEIN ELECTRPH","code_information":[{"code":"15650","type":"CDM"},{"code":"300","type":"RC"},{"code":"83700","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":206.05,"discounted_cash":103.03,"setting":"both","billing_class":"facility"}]},{"description":"HDL","code_information":[{"code":"15651","type":"CDM"},{"code":"300","type":"RC"},{"code":"83718","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.45,"discounted_cash":24.23,"setting":"both","billing_class":"facility"}]},{"description":"LDL","code_information":[{"code":"15652","type":"CDM"},{"code":"300","type":"RC"},{"code":"83721","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.6,"discounted_cash":23.8,"setting":"both","billing_class":"facility"}]},{"description":"MAGNESIUM SERUM","code_information":[{"code":"15654","type":"CDM"},{"code":"300","type":"RC"},{"code":"83735","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.15,"discounted_cash":26.07,"setting":"both","billing_class":"facility"}]},{"description":"MAGNESIUM OTH SRC","code_information":[{"code":"15655","type":"CDM"},{"code":"300","type":"RC"},{"code":"83735","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.15,"discounted_cash":29.07,"setting":"both","billing_class":"facility"}]},{"description":"ASSAY OF MANGANESE","code_information":[{"code":"15656","type":"CDM"},{"code":"301","type":"RC"},{"code":"83785","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":118.9,"discounted_cash":59.45,"setting":"both","billing_class":"facility"}]},{"description":"CLOZAPIN","code_information":[{"code":"15657","type":"CDM"},{"code":"300","type":"RC"},{"code":"83789","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":81.2,"discounted_cash":40.6,"setting":"both","billing_class":"facility"}]},{"description":"TPMT","code_information":[{"code":"15658","type":"CDM"},{"code":"300","type":"RC"},{"code":"83789","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":170.9,"discounted_cash":85.45,"setting":"both","billing_class":"facility"}]},{"description":"MYCOPHENOLIC ACID MS","code_information":[{"code":"15660","type":"CDM"},{"code":"300","type":"RC"},{"code":"83789","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":90.05,"discounted_cash":45.02,"setting":"both","billing_class":"facility"}]},{"description":"BILE ACIDS FX/TOTAL","code_information":[{"code":"15661","type":"CDM"},{"code":"300","type":"RC"},{"code":"83789","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.6,"discounted_cash":30.3,"setting":"both","billing_class":"facility"}]},{"description":"HYPOGLYCEMIC PANL QU","code_information":[{"code":"15662","type":"CDM"},{"code":"300","type":"RC"},{"code":"80377","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":253.3,"discounted_cash":126.65,"setting":"both","billing_class":"facility"}]},{"description":"MERCURY QUANT","code_information":[{"code":"15663","type":"CDM"},{"code":"301","type":"RC"},{"code":"83825","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.55,"discounted_cash":38.77,"setting":"both","billing_class":"facility"}]},{"description":"METANEPHRINES","code_information":[{"code":"15664","type":"CDM"},{"code":"300","type":"RC"},{"code":"83835","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.95,"discounted_cash":88.47,"setting":"both","billing_class":"facility"}]},{"description":"MYELIN BASIC PROTEIN","code_information":[{"code":"15666","type":"CDM"},{"code":"300","type":"RC"},{"code":"83873","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.45,"discounted_cash":44.23,"setting":"both","billing_class":"facility"}]},{"description":"MYOGLOBIN QUANT","code_information":[{"code":"15667","type":"CDM"},{"code":"300","type":"RC"},{"code":"83874","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.35,"discounted_cash":26.68,"setting":"both","billing_class":"facility"}]},{"description":"MYOGLOBIN QUAL","code_information":[{"code":"15668","type":"CDM"},{"code":"300","type":"RC"},{"code":"83874","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":56.05,"discounted_cash":28.02,"setting":"both","billing_class":"facility"}]},{"description":"HLA CLASS TYPING","code_information":[{"code":"15669","type":"CDM"},{"code":"300","type":"RC"},{"code":"81376","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":906.55,"discounted_cash":453.27,"setting":"both","billing_class":"facility"}]},{"description":"A1MGB UR","code_information":[{"code":"15670","type":"CDM"},{"code":"300","type":"RC"},{"code":"83883","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":521.15,"discounted_cash":260.57,"setting":"both","billing_class":"facility"}]},{"description":"NEPHELOMETRY EA ANA","code_information":[{"code":"15671","type":"CDM"},{"code":"300","type":"RC"},{"code":"83883","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.9,"discounted_cash":36.95,"setting":"both","billing_class":"facility"}]},{"description":"HEPATITIS PANEL 8","code_information":[{"code":"15691","type":"CDM"},{"code":"300","type":"RC"},{"code":"86704","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.95,"discounted_cash":41.98,"setting":"both","billing_class":"facility"}]},{"description":"FIBRBLST GRWH FAC 23","code_information":[{"code":"15703","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":477.55,"discounted_cash":238.78,"setting":"both","billing_class":"facility"}]},{"description":"HEP C VIRUS GENOTYPE","code_information":[{"code":"15711","type":"CDM"},{"code":"300","type":"RC"},{"code":"87902","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":739.95,"discounted_cash":369.98,"setting":"both","billing_class":"facility"}]},{"description":"MUTATION ANALYSIS","code_information":[{"code":"15716","type":"CDM"},{"code":"310","type":"RC"},{"code":"81402","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1134.55,"discounted_cash":567.27,"setting":"both","billing_class":"facility"}]},{"description":"5' NUCLEOTIDASE","code_information":[{"code":"15722","type":"CDM"},{"code":"300","type":"RC"},{"code":"83915","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":122.45,"discounted_cash":61.23,"setting":"both","billing_class":"facility"}]},{"description":"HEP B SURFCE AG QUAN","code_information":[{"code":"15723","type":"CDM"},{"code":"300","type":"RC"},{"code":"87467","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":71.9,"discounted_cash":35.95,"setting":"both","billing_class":"facility"}]},{"description":"OLIGOCLONAL BANDS","code_information":[{"code":"15724","type":"CDM"},{"code":"300","type":"RC"},{"code":"83916","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":100.25,"discounted_cash":50.13,"setting":"both","billing_class":"facility"}]},{"description":"OPIATES QUANT","code_information":[{"code":"15727","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":159.95,"discounted_cash":79.97,"setting":"both","billing_class":"facility"}]},{"description":"OSMOLALITY SERUM","code_information":[{"code":"15728","type":"CDM"},{"code":"300","type":"RC"},{"code":"83930","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":35.15,"setting":"both","billing_class":"facility"}]},{"description":"URINE OSMOLALITY","code_information":[{"code":"15729","type":"CDM"},{"code":"300","type":"RC"},{"code":"83935","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility"}]},{"description":"URINE OXALATE","code_information":[{"code":"15731","type":"CDM"},{"code":"300","type":"RC"},{"code":"83945","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":100.6,"discounted_cash":50.3,"setting":"both","billing_class":"facility"}]},{"description":"PTH INTACT","code_information":[{"code":"15734","type":"CDM"},{"code":"300","type":"RC"},{"code":"83970","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":167.25,"discounted_cash":83.63,"setting":"both","billing_class":"facility"}]},{"description":"PTH ANTIBODY","code_information":[{"code":"15736","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.4,"discounted_cash":212.7,"setting":"both","billing_class":"facility"}]},{"description":"PTH RELATED PROTEIN","code_information":[{"code":"15738","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.05,"discounted_cash":23.02,"setting":"both","billing_class":"facility"}]},{"description":"PH-BODY FLUID","code_information":[{"code":"15739","type":"CDM"},{"code":"300","type":"RC"},{"code":"83986","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.15,"discounted_cash":9.07,"setting":"both","billing_class":"facility"}]},{"description":"PH STOOL","code_information":[{"code":"15740","type":"CDM"},{"code":"300","type":"RC"},{"code":"83986","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.15,"discounted_cash":9.07,"setting":"both","billing_class":"facility"}]},{"description":"CALPROTECTIN","code_information":[{"code":"15741","type":"CDM"},{"code":"300","type":"RC"},{"code":"83993","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.8,"discounted_cash":110.9,"setting":"both","billing_class":"facility"}]},{"description":"ASSAY PHENCYCLIDINE","code_information":[{"code":"15744","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.2,"discounted_cash":219.1,"setting":"both","billing_class":"facility"}]},{"description":"T3 ANTIBODY","code_information":[{"code":"15748","type":"CDM"},{"code":"301","type":"RC"},{"code":"83519","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":143.0,"setting":"both","billing_class":"facility"}]},{"description":"ZIKA VIRUS RNA QUAL","code_information":[{"code":"15749","type":"CDM"},{"code":"306","type":"RC"},{"code":"87798","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":918.6,"discounted_cash":459.3,"setting":"both","billing_class":"facility"}]},{"description":"ADAMTS13 ACT W/REFLX","code_information":[{"code":"15750","type":"CDM"},{"code":"305","type":"RC"},{"code":"85397","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":316.05,"discounted_cash":158.03,"setting":"both","billing_class":"facility"}]},{"description":"GARDNERELLA VAG QT","code_information":[{"code":"15751","type":"CDM"},{"code":"306","type":"RC"},{"code":"87512","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":166.65,"discounted_cash":83.33,"setting":"both","billing_class":"facility"}]},{"description":"DETECT AGENT NOS QT","code_information":[{"code":"15752","type":"CDM"},{"code":"306","type":"RC"},{"code":"87799","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":193.3,"discounted_cash":96.65,"setting":"both","billing_class":"facility"}]},{"description":"CANDIDA DNA AMP PROB","code_information":[{"code":"15753","type":"CDM"},{"code":"306","type":"RC"},{"code":"87481","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":166.65,"discounted_cash":83.33,"setting":"both","billing_class":"facility"}]},{"description":"PKU  BLOOD","code_information":[{"code":"15755","type":"CDM"},{"code":"300","type":"RC"},{"code":"84030","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":127.25,"discounted_cash":63.63,"setting":"both","billing_class":"facility"}]},{"description":"ACID PHOSPH PROST (P","code_information":[{"code":"15757","type":"CDM"},{"code":"300","type":"RC"},{"code":"84066","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":60.6,"setting":"both","billing_class":"facility"}]},{"description":"ALKALINE PHOSPHATASE","code_information":[{"code":"15758","type":"CDM"},{"code":"300","type":"RC"},{"code":"84075","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.1,"discounted_cash":17.55,"setting":"both","billing_class":"facility"}]},{"description":"ALK/PHOS ISOENZYMES","code_information":[{"code":"15761","type":"CDM"},{"code":"300","type":"RC"},{"code":"84080","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.75,"discounted_cash":36.88,"setting":"both","billing_class":"facility"}]},{"description":"PHOSPHATIDYLGLY (PG)","code_information":[{"code":"15763","type":"CDM"},{"code":"300","type":"RC"},{"code":"84081","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":89.65,"discounted_cash":44.83,"setting":"both","billing_class":"facility"}]},{"description":"PHOSPHORUS INORG","code_information":[{"code":"15764","type":"CDM"},{"code":"300","type":"RC"},{"code":"84100","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.2,"discounted_cash":20.6,"setting":"both","billing_class":"facility"}]},{"description":"PHOSPHORUS URINE","code_information":[{"code":"15765","type":"CDM"},{"code":"300","type":"RC"},{"code":"84105","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.65,"discounted_cash":9.82,"setting":"both","billing_class":"facility"}]},{"description":"PORPHOBILINOGEN 24HR","code_information":[{"code":"15768","type":"CDM"},{"code":"300","type":"RC"},{"code":"84110","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":21.02,"setting":"both","billing_class":"facility"}]},{"description":"PORPHOBILINOGEN  QT","code_information":[{"code":"15769","type":"CDM"},{"code":"300","type":"RC"},{"code":"84110","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":90.85,"discounted_cash":45.42,"setting":"both","billing_class":"facility"}]},{"description":"AMNISURE","code_information":[{"code":"15770","type":"CDM"},{"code":"300","type":"RC"},{"code":"84112","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":255.7,"discounted_cash":127.85,"setting":"both","billing_class":"facility"}]},{"description":"PROTOPORPHYRIN RBC","code_information":[{"code":"15771","type":"CDM"},{"code":"301","type":"RC"},{"code":"84202","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.6,"discounted_cash":40.3,"setting":"both","billing_class":"facility"}]},{"description":"URINE PORPHYRINS QT","code_information":[{"code":"15774","type":"CDM"},{"code":"300","type":"RC"},{"code":"84120","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":35.15,"setting":"both","billing_class":"facility"}]},{"description":"POTASSIUM SERUM","code_information":[{"code":"15776","type":"CDM"},{"code":"300","type":"RC"},{"code":"84132","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.45,"discounted_cash":12.72,"setting":"both","billing_class":"facility"}]},{"description":"POTASSIUM URINE","code_information":[{"code":"15777","type":"CDM"},{"code":"300","type":"RC"},{"code":"84133","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":13.32,"setting":"both","billing_class":"facility"}]},{"description":"PREALBUMN","code_information":[{"code":"15779","type":"CDM"},{"code":"300","type":"RC"},{"code":"84134","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.6,"discounted_cash":30.3,"setting":"both","billing_class":"facility"}]},{"description":"PROGESTERONE","code_information":[{"code":"15781","type":"CDM"},{"code":"300","type":"RC"},{"code":"84144","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.55,"discounted_cash":47.77,"setting":"both","billing_class":"facility"}]},{"description":"PROLACTIN","code_information":[{"code":"15783","type":"CDM"},{"code":"300","type":"RC"},{"code":"84146","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":67.9,"discounted_cash":33.95,"setting":"both","billing_class":"facility"}]},{"description":"PSA TOTAL","code_information":[{"code":"15785","type":"CDM"},{"code":"300","type":"RC"},{"code":"84153","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":108.15,"discounted_cash":54.08,"setting":"both","billing_class":"facility"}]},{"description":"PSA FREE","code_information":[{"code":"15786","type":"CDM"},{"code":"300","type":"RC"},{"code":"84154","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":91.7,"discounted_cash":45.85,"setting":"both","billing_class":"facility"}]},{"description":"PSA SCREEN","code_information":[{"code":"15787","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0103","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":108.15,"discounted_cash":54.08,"setting":"both","billing_class":"facility"}]},{"description":"PROTEIN TOTAL","code_information":[{"code":"15788","type":"CDM"},{"code":"300","type":"RC"},{"code":"84155","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.35,"discounted_cash":18.18,"setting":"both","billing_class":"facility"}]},{"description":"PROT TOT BODY FLUID","code_information":[{"code":"15791","type":"CDM"},{"code":"300","type":"RC"},{"code":"84157","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":23.63,"setting":"both","billing_class":"facility"}]},{"description":"PROT TOT URINE","code_information":[{"code":"15792","type":"CDM"},{"code":"300","type":"RC"},{"code":"84156","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":21.2,"setting":"both","billing_class":"facility"}]},{"description":"PROTEIN ELECT F&Q","code_information":[{"code":"15797","type":"CDM"},{"code":"301","type":"RC"},{"code":"84165","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility"}]},{"description":"PROTEIN ELECT F&Q UR","code_information":[{"code":"15798","type":"CDM"},{"code":"300","type":"RC"},{"code":"84166","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.35,"discounted_cash":38.17,"setting":"both","billing_class":"facility"}]},{"description":"PROINSULIN","code_information":[{"code":"15801","type":"CDM"},{"code":"300","type":"RC"},{"code":"84206","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":178.2,"discounted_cash":89.1,"setting":"both","billing_class":"facility"}]},{"description":"VITAMN B-6","code_information":[{"code":"15802","type":"CDM"},{"code":"300","type":"RC"},{"code":"84207","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":147.85,"discounted_cash":73.92,"setting":"both","billing_class":"facility"}]},{"description":"TRANSFER REC ASSAY","code_information":[{"code":"15806","type":"CDM"},{"code":"300","type":"RC"},{"code":"84238","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":201.2,"discounted_cash":100.6,"setting":"both","billing_class":"facility"}]},{"description":"RENIN","code_information":[{"code":"15808","type":"CDM"},{"code":"300","type":"RC"},{"code":"84244","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility"}]},{"description":"SEROTONIN-BLOOD","code_information":[{"code":"15810","type":"CDM"},{"code":"300","type":"RC"},{"code":"84260","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.4,"discounted_cash":58.2,"setting":"both","billing_class":"facility"}]},{"description":"SEX HORMONE BND GLOB","code_information":[{"code":"15811","type":"CDM"},{"code":"300","type":"RC"},{"code":"84270","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.5,"discounted_cash":55.75,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM SERUM","code_information":[{"code":"15812","type":"CDM"},{"code":"300","type":"RC"},{"code":"84295","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":15.15,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM  URINE","code_information":[{"code":"15814","type":"CDM"},{"code":"300","type":"RC"},{"code":"84300","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":21.2,"setting":"both","billing_class":"facility"}]},{"description":"SOMATOMEDIN (IGF-1)","code_information":[{"code":"15816","type":"CDM"},{"code":"300","type":"RC"},{"code":"84305","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":129.65,"discounted_cash":64.83,"setting":"both","billing_class":"facility"}]},{"description":"IGF-1 LC/MS","code_information":[{"code":"15817","type":"CDM"},{"code":"300","type":"RC"},{"code":"84305","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.85,"discounted_cash":25.43,"setting":"both","billing_class":"facility"}]},{"description":"ADENOSNE DEAMINS FLD","code_information":[{"code":"15820","type":"CDM"},{"code":"300","type":"RC"},{"code":"84311","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":355.1,"discounted_cash":177.55,"setting":"both","billing_class":"facility"}]},{"description":"PYRROLES, URINE","code_information":[{"code":"15821","type":"CDM"},{"code":"300","type":"RC"},{"code":"84311","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":198.75,"discounted_cash":99.38,"setting":"both","billing_class":"facility"}]},{"description":"STOOL REDUCING SUBST","code_information":[{"code":"15824","type":"CDM"},{"code":"300","type":"RC"},{"code":"84376","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.4,"discounted_cash":13.7,"setting":"both","billing_class":"facility"}]},{"description":"TESTOSTERONE FREE","code_information":[{"code":"15826","type":"CDM"},{"code":"300","type":"RC"},{"code":"84402","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":153.95,"discounted_cash":76.97,"setting":"both","billing_class":"facility"}]},{"description":"TESTOSTERONE TOTAL","code_information":[{"code":"15827","type":"CDM"},{"code":"300","type":"RC"},{"code":"84403","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":118.75,"discounted_cash":59.38,"setting":"both","billing_class":"facility"}]},{"description":"VITAMN B-1 (THIAMNE)","code_information":[{"code":"15828","type":"CDM"},{"code":"300","type":"RC"},{"code":"84425","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":105.85,"discounted_cash":52.92,"setting":"both","billing_class":"facility"}]},{"description":"VITAMIN B-2","code_information":[{"code":"15829","type":"CDM"},{"code":"301","type":"RC"},{"code":"84252","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":105.85,"discounted_cash":52.92,"setting":"both","billing_class":"facility"}]},{"description":"THYROGLOBULIN","code_information":[{"code":"15830","type":"CDM"},{"code":"300","type":"RC"},{"code":"84432","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.6,"discounted_cash":30.3,"setting":"both","billing_class":"facility"}]},{"description":"T4 TOTAL","code_information":[{"code":"15831","type":"CDM"},{"code":"300","type":"RC"},{"code":"84436","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility"}]},{"description":"T4 FREE","code_information":[{"code":"15833","type":"CDM"},{"code":"300","type":"RC"},{"code":"84439","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.4,"discounted_cash":32.7,"setting":"both","billing_class":"facility"}]},{"description":"TSH","code_information":[{"code":"15835","type":"CDM"},{"code":"300","type":"RC"},{"code":"84443","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":60.6,"setting":"both","billing_class":"facility"}]},{"description":"TSH ANTIBODY","code_information":[{"code":"15836","type":"CDM"},{"code":"301","type":"RC"},{"code":"83519","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":270.25,"discounted_cash":135.13,"setting":"both","billing_class":"facility"}]},{"description":"CHEMILUMINESCENT ASS","code_information":[{"code":"15837","type":"CDM"},{"code":"300","type":"RC"},{"code":"82397","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":206.05,"discounted_cash":103.03,"setting":"both","billing_class":"facility"}]},{"description":"TSI (THYR STMG IMMNG","code_information":[{"code":"15840","type":"CDM"},{"code":"300","type":"RC"},{"code":"84445","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":230.25,"discounted_cash":115.13,"setting":"both","billing_class":"facility"}]},{"description":"VITAMN E (TOCOPHEROL","code_information":[{"code":"15841","type":"CDM"},{"code":"300","type":"RC"},{"code":"84446","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.9,"discounted_cash":16.95,"setting":"both","billing_class":"facility"}]},{"description":"AST/SGOT","code_information":[{"code":"15842","type":"CDM"},{"code":"300","type":"RC"},{"code":"84450","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.85,"discounted_cash":13.93,"setting":"both","billing_class":"facility"}]},{"description":"ALT/SGPT","code_information":[{"code":"15843","type":"CDM"},{"code":"300","type":"RC"},{"code":"84460","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.1,"discounted_cash":14.55,"setting":"both","billing_class":"facility"}]},{"description":"TRANSFERRIN","code_information":[{"code":"15844","type":"CDM"},{"code":"300","type":"RC"},{"code":"84466","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.7,"discounted_cash":36.35,"setting":"both","billing_class":"facility"}]},{"description":"TRIGLYCERIDE","code_information":[{"code":"15845","type":"CDM"},{"code":"300","type":"RC"},{"code":"84478","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.2,"discounted_cash":20.6,"setting":"both","billing_class":"facility"}]},{"description":"T3 UPTAKE","code_information":[{"code":"15846","type":"CDM"},{"code":"300","type":"RC"},{"code":"84479","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.55,"discounted_cash":47.27,"setting":"both","billing_class":"facility"}]},{"description":"T3 TOTAL","code_information":[{"code":"15847","type":"CDM"},{"code":"300","type":"RC"},{"code":"84480","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.2,"discounted_cash":52.1,"setting":"both","billing_class":"facility"}]},{"description":"T3 FREE","code_information":[{"code":"15848","type":"CDM"},{"code":"300","type":"RC"},{"code":"84481","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":163.65,"discounted_cash":81.83,"setting":"both","billing_class":"facility"}]},{"description":"T3 REVERSE","code_information":[{"code":"15849","type":"CDM"},{"code":"300","type":"RC"},{"code":"84482","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.6,"discounted_cash":39.3,"setting":"both","billing_class":"facility"}]},{"description":"TROPONIN QUANT","code_information":[{"code":"15850","type":"CDM"},{"code":"300","type":"RC"},{"code":"84484","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.95,"discounted_cash":48.48,"setting":"both","billing_class":"facility"}]},{"description":"HIGH SENS TROPONIN","code_information":[{"code":"15851","type":"CDM"},{"code":"301","type":"RC"},{"code":"84484","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":92.6,"discounted_cash":46.3,"setting":"both","billing_class":"facility"}]},{"description":"BUN","code_information":[{"code":"15853","type":"CDM"},{"code":"300","type":"RC"},{"code":"84520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":13.32,"setting":"both","billing_class":"facility"}]},{"description":"URINE UREA NITROGEN","code_information":[{"code":"15854","type":"CDM"},{"code":"300","type":"RC"},{"code":"84540","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":13.32,"setting":"both","billing_class":"facility"}]},{"description":"URIC ACID  BLOOD","code_information":[{"code":"15856","type":"CDM"},{"code":"300","type":"RC"},{"code":"84550","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":44.85,"discounted_cash":22.43,"setting":"both","billing_class":"facility"}]},{"description":"URIC ACID RANDOM UR","code_information":[{"code":"15859","type":"CDM"},{"code":"300","type":"RC"},{"code":"84560","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.35,"discounted_cash":26.68,"setting":"both","billing_class":"facility"}]},{"description":"VMA URINE","code_information":[{"code":"15860","type":"CDM"},{"code":"300","type":"RC"},{"code":"84585","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.3,"discounted_cash":38.65,"setting":"both","billing_class":"facility"}]},{"description":"VASOPRESSIN","code_information":[{"code":"15861","type":"CDM"},{"code":"300","type":"RC"},{"code":"84588","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":139.4,"discounted_cash":69.7,"setting":"both","billing_class":"facility"}]},{"description":"VITAMN A","code_information":[{"code":"15862","type":"CDM"},{"code":"300","type":"RC"},{"code":"84590","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.4,"discounted_cash":32.7,"setting":"both","billing_class":"facility"}]},{"description":"VITAMN K","code_information":[{"code":"15864","type":"CDM"},{"code":"300","type":"RC"},{"code":"84597","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.3,"discounted_cash":75.15,"setting":"both","billing_class":"facility"}]},{"description":"VOLATILES QL URINE","code_information":[{"code":"15866","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":206.05,"discounted_cash":103.03,"setting":"both","billing_class":"facility"}]},{"description":"ZINC","code_information":[{"code":"15871","type":"CDM"},{"code":"300","type":"RC"},{"code":"84630","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.35,"discounted_cash":29.68,"setting":"both","billing_class":"facility"}]},{"description":"C-PEPTIDE","code_information":[{"code":"15872","type":"CDM"},{"code":"300","type":"RC"},{"code":"84681","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.85,"discounted_cash":51.92,"setting":"both","billing_class":"facility"}]},{"description":"HCG SERUM QUANT","code_information":[{"code":"15873","type":"CDM"},{"code":"300","type":"RC"},{"code":"84702","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":122.45,"discounted_cash":61.23,"setting":"both","billing_class":"facility"}]},{"description":"HCG SERUM QUAL","code_information":[{"code":"15876","type":"CDM"},{"code":"300","type":"RC"},{"code":"84703","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.35,"discounted_cash":38.17,"setting":"both","billing_class":"facility"}]},{"description":"TORCH PANEL IGM","code_information":[{"code":"15877","type":"CDM"},{"code":"302","type":"RC"},{"code":"86645","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":297.3,"discounted_cash":148.65,"setting":"both","billing_class":"facility"}]},{"description":"OSMOLALITY STOOL","code_information":[{"code":"15880","type":"CDM"},{"code":"300","type":"RC"},{"code":"84999","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":4.25,"setting":"both","billing_class":"facility"}]},{"description":"DIFFERENTIAL-MANUAL","code_information":[{"code":"15890","type":"CDM"},{"code":"300","type":"RC"},{"code":"85007","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.8,"discounted_cash":16.4,"setting":"both","billing_class":"facility"}]},{"description":"HEMATOCRIT","code_information":[{"code":"15894","type":"CDM"},{"code":"300","type":"RC"},{"code":"85014","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.1,"discounted_cash":17.05,"setting":"both","billing_class":"facility"}]},{"description":"HEMOGLOBIN","code_information":[{"code":"15895","type":"CDM"},{"code":"300","type":"RC"},{"code":"85018","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.6,"discounted_cash":15.8,"setting":"both","billing_class":"facility"}]},{"description":"CBC W/AUTO DIFF","code_information":[{"code":"15897","type":"CDM"},{"code":"300","type":"RC"},{"code":"85025","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":74.55,"discounted_cash":37.27,"setting":"both","billing_class":"facility"}]},{"description":"CBC AUTO W/PLT WO/DF","code_information":[{"code":"15898","type":"CDM"},{"code":"300","type":"RC"},{"code":"85027","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":45.45,"discounted_cash":22.73,"setting":"both","billing_class":"facility"}]},{"description":"EBV NUCLEAR ANTIGEN","code_information":[{"code":"159","type":"CDM"},{"code":"300","type":"RC"},{"code":"86664","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.5,"discounted_cash":37.75,"setting":"both","billing_class":"facility"}]},{"description":"RETIC COUNT-FLOW CYT","code_information":[{"code":"15901","type":"CDM"},{"code":"300","type":"RC"},{"code":"85045","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.1,"discounted_cash":14.55,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR II","code_information":[{"code":"15913","type":"CDM"},{"code":"300","type":"RC"},{"code":"85210","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.45,"discounted_cash":53.73,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR V","code_information":[{"code":"15915","type":"CDM"},{"code":"300","type":"RC"},{"code":"85220","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.35,"discounted_cash":51.17,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR VII","code_information":[{"code":"15916","type":"CDM"},{"code":"305","type":"RC"},{"code":"85230","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":134.1,"discounted_cash":67.05,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR VIII ONE STAG","code_information":[{"code":"15917","type":"CDM"},{"code":"300","type":"RC"},{"code":"85240","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":121.4,"discounted_cash":60.7,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR VIII MULTI","code_information":[{"code":"15918","type":"CDM"},{"code":"300","type":"RC"},{"code":"85247","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.25,"discounted_cash":51.13,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR IX","code_information":[{"code":"15919","type":"CDM"},{"code":"300","type":"RC"},{"code":"85250","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.8,"discounted_cash":47.4,"setting":"both","billing_class":"facility"}]},{"description":"CAFFEINE QUANTITATIV","code_information":[{"code":"15920","type":"CDM"},{"code":"301","type":"RC"},{"code":"80155","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":163.65,"discounted_cash":81.83,"setting":"both","billing_class":"facility"}]},{"description":"ACYLCARNITINES QUANT","code_information":[{"code":"15921","type":"CDM"},{"code":"301","type":"RC"},{"code":"82017","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":85.15,"discounted_cash":42.58,"setting":"both","billing_class":"facility"}]},{"description":"ARTHROPOD EXAM","code_information":[{"code":"15922","type":"CDM"},{"code":"306","type":"RC"},{"code":"87168","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":13.32,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR X","code_information":[{"code":"15923","type":"CDM"},{"code":"300","type":"RC"},{"code":"85260","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.2,"discounted_cash":55.6,"setting":"both","billing_class":"facility"}]},{"description":"FCTR XA PRCNE/HPRN A","code_information":[{"code":"15924","type":"CDM"},{"code":"300","type":"RC"},{"code":"85520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":439.9,"discounted_cash":219.95,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR XA FRAGMIN","code_information":[{"code":"15925","type":"CDM"},{"code":"300","type":"RC"},{"code":"85520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":482.9,"discounted_cash":241.45,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR XI","code_information":[{"code":"15926","type":"CDM"},{"code":"300","type":"RC"},{"code":"85270","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":160.55,"discounted_cash":80.28,"setting":"both","billing_class":"facility"}]},{"description":"ZIKA VIRUS IGM","code_information":[{"code":"15927","type":"CDM"},{"code":"302","type":"RC"},{"code":"86794","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.6,"discounted_cash":40.3,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR XII","code_information":[{"code":"15929","type":"CDM"},{"code":"300","type":"RC"},{"code":"85280","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":160.55,"discounted_cash":80.28,"setting":"both","billing_class":"facility"}]},{"description":"ANTITHROMBIN III ACT","code_information":[{"code":"15930","type":"CDM"},{"code":"300","type":"RC"},{"code":"85300","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":56.9,"discounted_cash":28.45,"setting":"both","billing_class":"facility"}]},{"description":"ANTITHROMBIN III AG","code_information":[{"code":"15931","type":"CDM"},{"code":"305","type":"RC"},{"code":"85301","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":51.7,"discounted_cash":25.85,"setting":"both","billing_class":"facility"}]},{"description":"PROTEIN C ANTIGEN","code_information":[{"code":"15932","type":"CDM"},{"code":"300","type":"RC"},{"code":"85302","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.65,"discounted_cash":30.32,"setting":"both","billing_class":"facility"}]},{"description":"PROTEIN C ACTIVITY","code_information":[{"code":"15933","type":"CDM"},{"code":"300","type":"RC"},{"code":"85303","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.2,"discounted_cash":53.1,"setting":"both","billing_class":"facility"}]},{"description":"PROTHROMBIN AB","code_information":[{"code":"15934","type":"CDM"},{"code":"300","type":"RC"},{"code":"86849","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":139.95,"discounted_cash":69.97,"setting":"both","billing_class":"facility"}]},{"description":"PROTEIN S TOTAL","code_information":[{"code":"15935","type":"CDM"},{"code":"300","type":"RC"},{"code":"85305","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.9,"discounted_cash":18.95,"setting":"both","billing_class":"facility"}]},{"description":"PROTEIN S FREE","code_information":[{"code":"15937","type":"CDM"},{"code":"300","type":"RC"},{"code":"85306","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.55,"discounted_cash":34.77,"setting":"both","billing_class":"facility"}]},{"description":"ACT PROT C RES ASSAY","code_information":[{"code":"15938","type":"CDM"},{"code":"300","type":"RC"},{"code":"85307","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.1,"discounted_cash":38.55,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR INHIBITOR TES","code_information":[{"code":"15939","type":"CDM"},{"code":"300","type":"RC"},{"code":"85335","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.95,"discounted_cash":33.48,"setting":"both","billing_class":"facility"}]},{"description":"CYTOPATH C/V INTERPR","code_information":[{"code":"15940","type":"CDM"},{"code":"311","type":"RC"},{"code":"88141","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":101.85,"discounted_cash":50.92,"setting":"both","billing_class":"facility"}]},{"description":"TISS TRNSGLTMNSE IG","code_information":[{"code":"15941","type":"CDM"},{"code":"302","type":"RC"},{"code":"86364","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":6.05,"setting":"both","billing_class":"facility"}]},{"description":"RBC PRETX INCUB DENS","code_information":[{"code":"15942","type":"CDM"},{"code":"302","type":"RC"},{"code":"86972","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":538.65,"discounted_cash":269.32,"setting":"both","billing_class":"facility"}]},{"description":"FIBRIN SPLT PROD(FDP","code_information":[{"code":"15945","type":"CDM"},{"code":"300","type":"RC"},{"code":"85362","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.9,"discounted_cash":30.95,"setting":"both","billing_class":"facility"}]},{"description":"D-DIMER QUANT","code_information":[{"code":"15948","type":"CDM"},{"code":"300","type":"RC"},{"code":"85379","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":108.7,"discounted_cash":54.35,"setting":"both","billing_class":"facility"}]},{"description":"FIBRINOGEN  ACTIVITY","code_information":[{"code":"15949","type":"CDM"},{"code":"300","type":"RC"},{"code":"85384","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.8,"discounted_cash":37.9,"setting":"both","billing_class":"facility"}]},{"description":"PLASMINOGEN ACTIVATR","code_information":[{"code":"15952","type":"CDM"},{"code":"300","type":"RC"},{"code":"85415","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":164.35,"discounted_cash":82.17,"setting":"both","billing_class":"facility"}]},{"description":"LEUKOCYTE ALK PHOS","code_information":[{"code":"15955","type":"CDM"},{"code":"300","type":"RC"},{"code":"85540","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":147.9,"discounted_cash":73.95,"setting":"both","billing_class":"facility"}]},{"description":"STREP A DNA AMP PROB","code_information":[{"code":"15956","type":"CDM"},{"code":"306","type":"RC"},{"code":"87651","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":156.7,"discounted_cash":78.35,"setting":"both","billing_class":"facility"}]},{"description":"STAPH A DNA AMP PROB","code_information":[{"code":"15957","type":"CDM"},{"code":"306","type":"RC"},{"code":"87640","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":156.7,"discounted_cash":78.35,"setting":"both","billing_class":"facility"}]},{"description":"RBC FRAGILITY MECH","code_information":[{"code":"15958","type":"CDM"},{"code":"300","type":"RC"},{"code":"85547","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.65,"discounted_cash":27.82,"setting":"both","billing_class":"facility"}]},{"description":"MURAMIDASE (LYSOZYME","code_information":[{"code":"15959","type":"CDM"},{"code":"300","type":"RC"},{"code":"85549","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":97.55,"discounted_cash":48.77,"setting":"both","billing_class":"facility"}]},{"description":"TGSAP HL NEO 5-50DNA","code_information":[{"code":"15960","type":"CDM"},{"code":"310","type":"RC"},{"code":"81450","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2420.0,"discounted_cash":1210.0,"setting":"both","billing_class":"facility"}]},{"description":"ONC AML DNA DETCJ/NO","code_information":[{"code":"15961","type":"CDM"},{"code":"310","type":"RC"},{"code":"0023U","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":950.75,"discounted_cash":475.38,"setting":"both","billing_class":"facility"}]},{"description":"PT","code_information":[{"code":"15967","type":"CDM"},{"code":"300","type":"RC"},{"code":"85610","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.65,"discounted_cash":18.32,"setting":"both","billing_class":"facility"}]},{"description":"DRVVT","code_information":[{"code":"15968","type":"CDM"},{"code":"300","type":"RC"},{"code":"85613","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.15,"discounted_cash":41.08,"setting":"both","billing_class":"facility"}]},{"description":"ESR NONAUTO","code_information":[{"code":"15969","type":"CDM"},{"code":"300","type":"RC"},{"code":"85651","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.3,"discounted_cash":36.65,"setting":"both","billing_class":"facility"}]},{"description":"SICKLE CELL SCREEN","code_information":[{"code":"15970","type":"CDM"},{"code":"305","type":"RC"},{"code":"85660","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":28.15,"discounted_cash":14.07,"setting":"both","billing_class":"facility"}]},{"description":"THROMBIN TIME","code_information":[{"code":"15971","type":"CDM"},{"code":"300","type":"RC"},{"code":"85670","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.1,"discounted_cash":14.55,"setting":"both","billing_class":"facility"}]},{"description":"PTT","code_information":[{"code":"15973","type":"CDM"},{"code":"300","type":"RC"},{"code":"85730","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.9,"discounted_cash":30.95,"setting":"both","billing_class":"facility"}]},{"description":"APTT","code_information":[{"code":"15975","type":"CDM"},{"code":"305","type":"RC"},{"code":"85732","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.85,"discounted_cash":17.43,"setting":"both","billing_class":"facility"}]},{"description":"VISCOSITY","code_information":[{"code":"15976","type":"CDM"},{"code":"300","type":"RC"},{"code":"85810","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.9,"discounted_cash":30.95,"setting":"both","billing_class":"facility"}]},{"description":"DRUG TEST DEFINITIVE","code_information":[{"code":"15983","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":208.0,"setting":"both","billing_class":"facility"}]},{"description":"PLATELET ABS","code_information":[{"code":"15984","type":"CDM"},{"code":"300","type":"RC"},{"code":"86022","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":137.3,"discounted_cash":68.65,"setting":"both","billing_class":"facility"}]},{"description":"PLATELET ANTIBOBY DT","code_information":[{"code":"15985","type":"CDM"},{"code":"302","type":"RC"},{"code":"86023","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":34.65,"setting":"both","billing_class":"facility"}]},{"description":"Q FEVER ANTIBODY","code_information":[{"code":"15986","type":"CDM"},{"code":"302","type":"RC"},{"code":"86638","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":67.3,"discounted_cash":33.65,"setting":"both","billing_class":"facility"}]},{"description":"EHRLICHIA ANTIBODY","code_information":[{"code":"15987","type":"CDM"},{"code":"302","type":"RC"},{"code":"86666","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":56.7,"discounted_cash":28.35,"setting":"both","billing_class":"facility"}]},{"description":"UREA BREATH TEST","code_information":[{"code":"15988","type":"CDM"},{"code":"301","type":"RC"},{"code":"83013","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":294.8,"discounted_cash":147.4,"setting":"both","billing_class":"facility"}]},{"description":"ANA","code_information":[{"code":"15989","type":"CDM"},{"code":"300","type":"RC"},{"code":"86038","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":169.3,"discounted_cash":84.65,"setting":"both","billing_class":"facility"}]},{"description":"ALLERGEN IGE EACH","code_information":[{"code":"15990","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":15.75,"setting":"both","billing_class":"facility"}]},{"description":"ANTI CENTROMERE ANA","code_information":[{"code":"15991","type":"CDM"},{"code":"300","type":"RC"},{"code":"86038","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.3,"discounted_cash":33.15,"setting":"both","billing_class":"facility"}]},{"description":"ANA TITER","code_information":[{"code":"15992","type":"CDM"},{"code":"300","type":"RC"},{"code":"86039","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":93.35,"discounted_cash":46.67,"setting":"both","billing_class":"facility"}]},{"description":"ASO TITER","code_information":[{"code":"15993","type":"CDM"},{"code":"300","type":"RC"},{"code":"86060","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility"}]},{"description":"CRP","code_information":[{"code":"15996","type":"CDM"},{"code":"300","type":"RC"},{"code":"86140","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.95,"discounted_cash":29.98,"setting":"both","billing_class":"facility"}]},{"description":"CRP HIGH SENS","code_information":[{"code":"15997","type":"CDM"},{"code":"300","type":"RC"},{"code":"86141","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.3,"discounted_cash":54.65,"setting":"both","billing_class":"facility"}]},{"description":"APPL UNNA BOOT BILAT","code_information":[{"code":"16","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":766.2,"discounted_cash":383.1,"setting":"both","billing_class":"facility"}]},{"description":"EBV VIRAL CAPSID","code_information":[{"code":"160","type":"CDM"},{"code":"300","type":"RC"},{"code":"86665","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":93.35,"discounted_cash":46.67,"setting":"both","billing_class":"facility"}]},{"description":"B2 GLYCOPROT I AB EA","code_information":[{"code":"16001","type":"CDM"},{"code":"300","type":"RC"},{"code":"86146","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":105.3,"discounted_cash":52.65,"setting":"both","billing_class":"facility"}]},{"description":"AB CARDIOLIPIN","code_information":[{"code":"16002","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.7,"discounted_cash":65.35,"setting":"both","billing_class":"facility"}]},{"description":"HPRCOAG","code_information":[{"code":"16003","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1206.55,"discounted_cash":603.27,"setting":"both","billing_class":"facility"}]},{"description":"LIVER DS ALYS 3 BMRK","code_information":[{"code":"16004","type":"CDM"},{"code":"310","type":"RC"},{"code":"81517","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1601.5,"discounted_cash":800.75,"setting":"both","billing_class":"facility"}]},{"description":"ASSAY ANTI-MULLERIAN","code_information":[{"code":"16005","type":"CDM"},{"code":"301","type":"RC"},{"code":"82166","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":172.25,"discounted_cash":86.13,"setting":"both","billing_class":"facility"}]},{"description":"ACETYLCHOLN RCPT BND","code_information":[{"code":"16006","type":"CDM"},{"code":"302","type":"RC"},{"code":"86041","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility"}]},{"description":"ACETYLCHLN RCPT BLCK","code_information":[{"code":"16007","type":"CDM"},{"code":"302","type":"RC"},{"code":"86042","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility"}]},{"description":"ACETYLCHOLN RCPT MOD","code_information":[{"code":"16008","type":"CDM"},{"code":"302","type":"RC"},{"code":"86043","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.75,"discounted_cash":29.88,"setting":"both","billing_class":"facility"}]},{"description":"MUSCLE-SPECIFIC KINA","code_information":[{"code":"16009","type":"CDM"},{"code":"302","type":"RC"},{"code":"86366","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility"}]},{"description":"HEPATITIS D QUANT","code_information":[{"code":"16010","type":"CDM"},{"code":"306","type":"RC"},{"code":"87523","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":191.25,"discounted_cash":95.63,"setting":"both","billing_class":"facility"}]},{"description":"PHOSPHATIDYLSER AB","code_information":[{"code":"16011","type":"CDM"},{"code":"300","type":"RC"},{"code":"86148","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility"}]},{"description":"HLA II TYPING 1 LOC","code_information":[{"code":"16012","type":"CDM"},{"code":"301","type":"RC"},{"code":"81382","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":472.75,"discounted_cash":236.38,"setting":"both","billing_class":"facility"}]},{"description":"COLD AGGLUTININ TITE","code_information":[{"code":"16014","type":"CDM"},{"code":"300","type":"RC"},{"code":"86157","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":44.2,"discounted_cash":22.1,"setting":"both","billing_class":"facility"}]},{"description":"COLLAGEN CROSS LINKS","code_information":[{"code":"16015","type":"CDM"},{"code":"300","type":"RC"},{"code":"82523","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":218.15,"discounted_cash":109.08,"setting":"both","billing_class":"facility"}]},{"description":"N-TELOPTPTDE 24HR UR","code_information":[{"code":"16016","type":"CDM"},{"code":"300","type":"RC"},{"code":"82523","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":133.3,"discounted_cash":66.65,"setting":"both","billing_class":"facility"}]},{"description":"ALLG SPEC IGE CRUDE","code_information":[{"code":"16020","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":15.75,"setting":"both","billing_class":"facility"}]},{"description":"COMPLEMENT ANTIGEN","code_information":[{"code":"16021","type":"CDM"},{"code":"300","type":"RC"},{"code":"86160","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.65,"discounted_cash":63.33,"setting":"both","billing_class":"facility"}]},{"description":"C1 ESTERASE FUNCTION","code_information":[{"code":"16026","type":"CDM"},{"code":"300","type":"RC"},{"code":"86161","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.35,"discounted_cash":26.68,"setting":"both","billing_class":"facility"}]},{"description":"COMPLEMENT CH50","code_information":[{"code":"16027","type":"CDM"},{"code":"300","type":"RC"},{"code":"86162","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility"}]},{"description":"CCP AB","code_information":[{"code":"16030","type":"CDM"},{"code":"300","type":"RC"},{"code":"86200","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":81.3,"discounted_cash":40.65,"setting":"both","billing_class":"facility"}]},{"description":"AB DNASE TITER","code_information":[{"code":"16031","type":"CDM"},{"code":"300","type":"RC"},{"code":"86215","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.65,"discounted_cash":36.33,"setting":"both","billing_class":"facility"}]},{"description":"IFA ANTIBODY SCREEN","code_information":[{"code":"16033","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.35,"discounted_cash":26.68,"setting":"both","billing_class":"facility"}]},{"description":"AB DNA DS","code_information":[{"code":"16034","type":"CDM"},{"code":"302","type":"RC"},{"code":"86225","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.4,"discounted_cash":37.7,"setting":"both","billing_class":"facility"}]},{"description":"AB DNA SS","code_information":[{"code":"16035","type":"CDM"},{"code":"300","type":"RC"},{"code":"86226","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":121.3,"discounted_cash":60.65,"setting":"both","billing_class":"facility"}]},{"description":"AQUAPORIN-4 ANTB CBA","code_information":[{"code":"16036","type":"CDM"},{"code":"302","type":"RC"},{"code":"86052","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":28.88,"setting":"both","billing_class":"facility"}]},{"description":"PROGESTERONE FREE","code_information":[{"code":"16037","type":"CDM"},{"code":"301","type":"RC"},{"code":"84144","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":93.2,"discounted_cash":46.6,"setting":"both","billing_class":"facility"}]},{"description":"AB RNP","code_information":[{"code":"16039","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":114.65,"discounted_cash":57.33,"setting":"both","billing_class":"facility"}]},{"description":"AB SCLERODERMA","code_information":[{"code":"16041","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":114.65,"discounted_cash":57.33,"setting":"both","billing_class":"facility"}]},{"description":"AB SJOGRENS SSA","code_information":[{"code":"16042","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":114.65,"discounted_cash":57.33,"setting":"both","billing_class":"facility"}]},{"description":"AB SJOGREN'S SSB","code_information":[{"code":"16043","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":114.65,"discounted_cash":57.33,"setting":"both","billing_class":"facility"}]},{"description":"AB SMITH","code_information":[{"code":"16049","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":114.65,"discounted_cash":57.33,"setting":"both","billing_class":"facility"}]},{"description":"DIHYDROTESTOSTERONE","code_information":[{"code":"16052","type":"CDM"},{"code":"301","type":"RC"},{"code":"82642","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.95,"discounted_cash":65.47,"setting":"both","billing_class":"facility"}]},{"description":"DRUG SCRN BARBITURAT","code_information":[{"code":"16053","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.2,"discounted_cash":112.1,"setting":"both","billing_class":"facility"}]},{"description":"AB MITOCHONDRIAL","code_information":[{"code":"16054","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.1,"discounted_cash":33.05,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNOASSAY QUALT","code_information":[{"code":"16058","type":"CDM"},{"code":"302","type":"RC"},{"code":"86255","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility"}]},{"description":"PROTEIN WESTERN BLOT","code_information":[{"code":"16059","type":"CDM"},{"code":"301","type":"RC"},{"code":"84182","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility"}]},{"description":"CHROMOSOME ANLYSIS 5","code_information":[{"code":"16061","type":"CDM"},{"code":"310","type":"RC"},{"code":"88261","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.6,"discounted_cash":441.8,"setting":"both","billing_class":"facility"}]},{"description":"TISSUE CULTURE TUMOR","code_information":[{"code":"16062","type":"CDM"},{"code":"311","type":"RC"},{"code":"88239","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":538.0,"discounted_cash":269.0,"setting":"both","billing_class":"facility"}]},{"description":"HU AB W REFLEX TIT W","code_information":[{"code":"16068","type":"CDM"},{"code":"302","type":"RC"},{"code":"86255","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.65,"discounted_cash":41.33,"setting":"both","billing_class":"facility"}]},{"description":"HU YO RI ANTIBD R WB","code_information":[{"code":"16069","type":"CDM"},{"code":"302","type":"RC"},{"code":"86255","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.65,"discounted_cash":41.33,"setting":"both","billing_class":"facility"}]},{"description":"AB ENDOMYSIAL","code_information":[{"code":"16071","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.1,"discounted_cash":33.05,"setting":"both","billing_class":"facility"}]},{"description":"AB THYROID PEROXIDAS","code_information":[{"code":"16077","type":"CDM"},{"code":"302","type":"RC"},{"code":"86376","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.35,"discounted_cash":34.67,"setting":"both","billing_class":"facility"}]},{"description":"AB LIVER/KIDNEY EACH","code_information":[{"code":"16078","type":"CDM"},{"code":"300","type":"RC"},{"code":"86376","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNA SARS COV2 SSM","code_information":[{"code":"16080","type":"CDM"},{"code":"302","type":"RC"},{"code":"86328","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":242.4,"discounted_cash":121.2,"setting":"both","billing_class":"facility"}]},{"description":"ANTBDY SARS COV2","code_information":[{"code":"16081","type":"CDM"},{"code":"302","type":"RC"},{"code":"86769","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":242.4,"discounted_cash":121.2,"setting":"both","billing_class":"facility"}]},{"description":"FECAL POTASSIUM","code_information":[{"code":"16083","type":"CDM"},{"code":"301","type":"RC"},{"code":"84999","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":21.2,"setting":"both","billing_class":"facility"}]},{"description":"DRUG SCRN ZONISAMIDE","code_information":[{"code":"16084","type":"CDM"},{"code":"301","type":"RC"},{"code":"80203","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.3,"discounted_cash":31.65,"setting":"both","billing_class":"facility"}]},{"description":"AB ACETYLCHOLINE REC","code_information":[{"code":"16086","type":"CDM"},{"code":"302","type":"RC"},{"code":"86256","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.55,"discounted_cash":28.77,"setting":"both","billing_class":"facility"}]},{"description":"MONO SCREEN","code_information":[{"code":"16091","type":"CDM"},{"code":"300","type":"RC"},{"code":"86308","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.65,"discounted_cash":47.33,"setting":"both","billing_class":"facility"}]},{"description":"CA 125","code_information":[{"code":"16095","type":"CDM"},{"code":"300","type":"RC"},{"code":"86304","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility"}]},{"description":"CA 19-9","code_information":[{"code":"16096","type":"CDM"},{"code":"300","type":"RC"},{"code":"86301","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.45,"discounted_cash":39.23,"setting":"both","billing_class":"facility"}]},{"description":"CA 15-3","code_information":[{"code":"16097","type":"CDM"},{"code":"300","type":"RC"},{"code":"86300","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.95,"discounted_cash":47.98,"setting":"both","billing_class":"facility"}]},{"description":"CA 27-29","code_information":[{"code":"16098","type":"CDM"},{"code":"300","type":"RC"},{"code":"86300","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.95,"discounted_cash":47.98,"setting":"both","billing_class":"facility"}]},{"description":"BUPREN & METAB SCRN","code_information":[{"code":"16103","type":"CDM"},{"code":"301","type":"RC"},{"code":"80307","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.35,"discounted_cash":189.68,"setting":"both","billing_class":"facility"}]},{"description":"AB BARTONELLA","code_information":[{"code":"16104","type":"CDM"},{"code":"300","type":"RC"},{"code":"86611","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":81.3,"discounted_cash":40.65,"setting":"both","billing_class":"facility"}]},{"description":"BARTONELLA DNA, PCR","code_information":[{"code":"16105","type":"CDM"},{"code":"306","type":"RC"},{"code":"87471","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":583.95,"discounted_cash":291.98,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNOELECTRO URINE","code_information":[{"code":"16109","type":"CDM"},{"code":"300","type":"RC"},{"code":"86325","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":125.3,"discounted_cash":62.65,"setting":"both","billing_class":"facility"}]},{"description":"C1Q IMMUNE COMPLEX","code_information":[{"code":"16111","type":"CDM"},{"code":"300","type":"RC"},{"code":"86332","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":133.7,"discounted_cash":66.85,"setting":"both","billing_class":"facility"}]},{"description":"INHIBIN A","code_information":[{"code":"16112","type":"CDM"},{"code":"300","type":"RC"},{"code":"86336","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":81.3,"discounted_cash":40.65,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNOFIX ELECTROPH","code_information":[{"code":"16113","type":"CDM"},{"code":"302","type":"RC"},{"code":"86334","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":99.95,"discounted_cash":49.98,"setting":"both","billing_class":"facility"}]},{"description":"AB INTRINSIC FACTOR","code_information":[{"code":"16114","type":"CDM"},{"code":"300","type":"RC"},{"code":"86340","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.35,"discounted_cash":38.67,"setting":"both","billing_class":"facility"}]},{"description":"HISTAMINE RELEASE","code_information":[{"code":"16117","type":"CDM"},{"code":"300","type":"RC"},{"code":"86343","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":301.35,"discounted_cash":150.68,"setting":"both","billing_class":"facility"}]},{"description":"T CELL CLONALITIY","code_information":[{"code":"16118","type":"CDM"},{"code":"310","type":"RC"},{"code":"81342","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1470.5,"discounted_cash":735.25,"setting":"both","billing_class":"facility"}]},{"description":"T CELLS TOTAL COUNT","code_information":[{"code":"16119","type":"CDM"},{"code":"302","type":"RC"},{"code":"86359","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":168.15,"discounted_cash":84.08,"setting":"both","billing_class":"facility"}]},{"description":"T-CELL CLONALITY PAN","code_information":[{"code":"16121","type":"CDM"},{"code":"310","type":"RC"},{"code":"81340","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1467.9,"discounted_cash":733.95,"setting":"both","billing_class":"facility"}]},{"description":"B-CELL CLONALTY PANL","code_information":[{"code":"16122","type":"CDM"},{"code":"310","type":"RC"},{"code":"81261","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1191.9,"discounted_cash":595.95,"setting":"both","billing_class":"facility"}]},{"description":"MICROSATLLTE INSTABL","code_information":[{"code":"16123","type":"CDM"},{"code":"310","type":"RC"},{"code":"81301","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1456.25,"discounted_cash":728.13,"setting":"both","billing_class":"facility"}]},{"description":"CD4 & CD8 COUNT W/RA","code_information":[{"code":"16124","type":"CDM"},{"code":"300","type":"RC"},{"code":"86360","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":257.75,"discounted_cash":128.88,"setting":"both","billing_class":"facility"}]},{"description":"CD 4  T CELLS ABSOLU","code_information":[{"code":"16125","type":"CDM"},{"code":"302","type":"RC"},{"code":"86361","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.3,"discounted_cash":63.15,"setting":"both","billing_class":"facility"}]},{"description":"VIRAL AB NEUTRALIZE","code_information":[{"code":"16127","type":"CDM"},{"code":"302","type":"RC"},{"code":"86382","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":137.3,"discounted_cash":68.65,"setting":"both","billing_class":"facility"}]},{"description":"RABIES TITER","code_information":[{"code":"16128","type":"CDM"},{"code":"302","type":"RC"},{"code":"86382","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility"}]},{"description":"FLUORIDE, PLASMA","code_information":[{"code":"16129","type":"CDM"},{"code":"300","type":"RC"},{"code":"82735","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":60.6,"setting":"both","billing_class":"facility"}]},{"description":"AB MICROSOMAL  EA","code_information":[{"code":"16130","type":"CDM"},{"code":"300","type":"RC"},{"code":"86376","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":79.8,"discounted_cash":39.9,"setting":"both","billing_class":"facility"}]},{"description":"NK CELL TOTAL COUNT","code_information":[{"code":"16131","type":"CDM"},{"code":"302","type":"RC"},{"code":"86357","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":168.15,"discounted_cash":84.08,"setting":"both","billing_class":"facility"}]},{"description":"CRYPTOCOCCUS ANTIGEN","code_information":[{"code":"16136","type":"CDM"},{"code":"300","type":"RC"},{"code":"86403","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.6,"discounted_cash":23.3,"setting":"both","billing_class":"facility"}]},{"description":"STREP AGALACTICEA AN","code_information":[{"code":"16150","type":"CDM"},{"code":"300","type":"RC"},{"code":"86403","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.3,"discounted_cash":54.65,"setting":"both","billing_class":"facility"}]},{"description":"RA FACTOR QUANT","code_information":[{"code":"16152","type":"CDM"},{"code":"300","type":"RC"},{"code":"86431","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":93.35,"discounted_cash":46.67,"setting":"both","billing_class":"facility"}]},{"description":"QUANTIFERON","code_information":[{"code":"16153","type":"CDM"},{"code":"300","type":"RC"},{"code":"86480","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":340.05,"discounted_cash":170.03,"setting":"both","billing_class":"facility"}]},{"description":"STREPTOCOCCUS SCREEN","code_information":[{"code":"16159","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility"}]},{"description":"LYME DISEASE DNA PCR","code_information":[{"code":"16161","type":"CDM"},{"code":"300","type":"RC"},{"code":"87801","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":766.55,"discounted_cash":383.27,"setting":"both","billing_class":"facility"}]},{"description":"STREP DIR OPT OBS","code_information":[{"code":"16162","type":"CDM"},{"code":"300","type":"RC"},{"code":"87880","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility"}]},{"description":"VDRL-CSF","code_information":[{"code":"16163","type":"CDM"},{"code":"300","type":"RC"},{"code":"86592","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.35,"discounted_cash":30.68,"setting":"both","billing_class":"facility"}]},{"description":"RPR QUAL","code_information":[{"code":"16165","type":"CDM"},{"code":"300","type":"RC"},{"code":"86592","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.35,"discounted_cash":30.68,"setting":"both","billing_class":"facility"}]},{"description":"RPR/VDRL QUANT","code_information":[{"code":"16166","type":"CDM"},{"code":"302","type":"RC"},{"code":"86593","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.55,"discounted_cash":11.28,"setting":"both","billing_class":"facility"}]},{"description":"AB ADENOVIRUS","code_information":[{"code":"16167","type":"CDM"},{"code":"300","type":"RC"},{"code":"86603","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":64.0,"setting":"both","billing_class":"facility"}]},{"description":"AB ASPERGILLUS","code_information":[{"code":"16168","type":"CDM"},{"code":"302","type":"RC"},{"code":"86606","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.5,"discounted_cash":37.75,"setting":"both","billing_class":"facility"}]},{"description":"ASPRGLLS ANTIGEN EIA","code_information":[{"code":"16169","type":"CDM"},{"code":"300","type":"RC"},{"code":"87305","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":286.6,"discounted_cash":143.3,"setting":"both","billing_class":"facility"}]},{"description":"AB BLASTOMYCES","code_information":[{"code":"16174","type":"CDM"},{"code":"302","type":"RC"},{"code":"86612","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.65,"discounted_cash":35.33,"setting":"both","billing_class":"facility"}]},{"description":"AB B PERTUSSIS","code_information":[{"code":"16175","type":"CDM"},{"code":"300","type":"RC"},{"code":"86615","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.4,"discounted_cash":36.2,"setting":"both","billing_class":"facility"}]},{"description":"AB LYME DISEASE","code_information":[{"code":"16179","type":"CDM"},{"code":"300","type":"RC"},{"code":"86618","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.3,"discounted_cash":54.65,"setting":"both","billing_class":"facility"}]},{"description":"AB BRUCELLA","code_information":[{"code":"16180","type":"CDM"},{"code":"300","type":"RC"},{"code":"86622","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.35,"discounted_cash":24.68,"setting":"both","billing_class":"facility"}]},{"description":"CANDIDA ANTIGEN","code_information":[{"code":"16182","type":"CDM"},{"code":"302","type":"RC"},{"code":"86403","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":88.0,"setting":"both","billing_class":"facility"}]},{"description":"AB CHLAMYDIA","code_information":[{"code":"16183","type":"CDM"},{"code":"300","type":"RC"},{"code":"86631","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.9,"discounted_cash":32.45,"setting":"both","billing_class":"facility"}]},{"description":"AB CHLAMYDIA IGM","code_information":[{"code":"16185","type":"CDM"},{"code":"300","type":"RC"},{"code":"86632","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.65,"discounted_cash":35.33,"setting":"both","billing_class":"facility"}]},{"description":"AB COCCIDIOIDES","code_information":[{"code":"16188","type":"CDM"},{"code":"302","type":"RC"},{"code":"86635","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.95,"discounted_cash":31.48,"setting":"both","billing_class":"facility"}]},{"description":"AB CMV","code_information":[{"code":"16190","type":"CDM"},{"code":"300","type":"RC"},{"code":"86644","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.95,"discounted_cash":39.48,"setting":"both","billing_class":"facility"}]},{"description":"AB CMV IGM","code_information":[{"code":"16191","type":"CDM"},{"code":"300","type":"RC"},{"code":"86645","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":137.3,"discounted_cash":68.65,"setting":"both","billing_class":"facility"}]},{"description":"AB DIPTHERIA","code_information":[{"code":"16192","type":"CDM"},{"code":"300","type":"RC"},{"code":"86648","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.5,"discounted_cash":37.75,"setting":"both","billing_class":"facility"}]},{"description":"AB ENCEPHALITIS CA","code_information":[{"code":"16194","type":"CDM"},{"code":"300","type":"RC"},{"code":"86651","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.4,"discounted_cash":36.2,"setting":"both","billing_class":"facility"}]},{"description":"EBV VIRAL CAPSID IGM","code_information":[{"code":"162","type":"CDM"},{"code":"300","type":"RC"},{"code":"86665","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":93.35,"discounted_cash":46.67,"setting":"both","billing_class":"facility"}]},{"description":"AB EBV EARLY AG","code_information":[{"code":"16205","type":"CDM"},{"code":"300","type":"RC"},{"code":"86663","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.3,"discounted_cash":36.65,"setting":"both","billing_class":"facility"}]},{"description":"AB EBV NUC AG","code_information":[{"code":"16206","type":"CDM"},{"code":"300","type":"RC"},{"code":"86664","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.35,"discounted_cash":37.67,"setting":"both","billing_class":"facility"}]},{"description":"EBV IGG/IGM","code_information":[{"code":"16207","type":"CDM"},{"code":"300","type":"RC"},{"code":"86665","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.95,"discounted_cash":41.98,"setting":"both","billing_class":"facility"}]},{"description":"HIV-1 AG HIV1&2 AB A","code_information":[{"code":"16208","type":"CDM"},{"code":"306","type":"RC"},{"code":"87389","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.05,"discounted_cash":55.52,"setting":"both","billing_class":"facility"}]},{"description":"AB FUNGUS NOS","code_information":[{"code":"16211","type":"CDM"},{"code":"302","type":"RC"},{"code":"86671","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.95,"discounted_cash":27.98,"setting":"both","billing_class":"facility"}]},{"description":"SACCHAROMYC CERV AB","code_information":[{"code":"16212","type":"CDM"},{"code":"300","type":"RC"},{"code":"86671","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility"}]},{"description":"AB GIARDIA LAMBLIA","code_information":[{"code":"16213","type":"CDM"},{"code":"300","type":"RC"},{"code":"86674","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility"}]},{"description":"AB HELICOBACTER PYLO","code_information":[{"code":"16214","type":"CDM"},{"code":"300","type":"RC"},{"code":"86677","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":89.35,"discounted_cash":44.67,"setting":"both","billing_class":"facility"}]},{"description":"AB HTLV/HIV CONFIRM","code_information":[{"code":"16215","type":"CDM"},{"code":"300","type":"RC"},{"code":"86689","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":293.3,"discounted_cash":146.65,"setting":"both","billing_class":"facility"}]},{"description":"HEP D VIRUS IGM AB","code_information":[{"code":"16217","type":"CDM"},{"code":"302","type":"RC"},{"code":"86692","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":191.95,"discounted_cash":95.97,"setting":"both","billing_class":"facility"}]},{"description":"HEP E AB","code_information":[{"code":"16218","type":"CDM"},{"code":"302","type":"RC"},{"code":"86790","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.3,"discounted_cash":86.65,"setting":"both","billing_class":"facility"}]},{"description":"HERPES SIMPLEX NES A","code_information":[{"code":"16219","type":"CDM"},{"code":"302","type":"RC"},{"code":"86694","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":68.75,"discounted_cash":34.38,"setting":"both","billing_class":"facility"}]},{"description":"AB HERPES TYPE II","code_information":[{"code":"16220","type":"CDM"},{"code":"300","type":"RC"},{"code":"86696","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.3,"discounted_cash":36.65,"setting":"both","billing_class":"facility"}]},{"description":"AB HISTOPLASMA","code_information":[{"code":"16223","type":"CDM"},{"code":"302","type":"RC"},{"code":"86698","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":90.65,"discounted_cash":45.33,"setting":"both","billing_class":"facility"}]},{"description":"AB HIV-1","code_information":[{"code":"16224","type":"CDM"},{"code":"302","type":"RC"},{"code":"86701","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":45.4,"discounted_cash":22.7,"setting":"both","billing_class":"facility"}]},{"description":"AB HIV-2","code_information":[{"code":"16225","type":"CDM"},{"code":"302","type":"RC"},{"code":"86702","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":32.25,"setting":"both","billing_class":"facility"}]},{"description":"HIV 1/2 ANTIBODY ANT","code_information":[{"code":"16226","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0433","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility"}]},{"description":"B NATRIURETIC PEPTID","code_information":[{"code":"16227","type":"CDM"},{"code":"300","type":"RC"},{"code":"83880","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":133.3,"discounted_cash":66.65,"setting":"both","billing_class":"facility"}]},{"description":"HEP B CORE AB TOTAL","code_information":[{"code":"16228","type":"CDM"},{"code":"302","type":"RC"},{"code":"86704","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.6,"discounted_cash":23.3,"setting":"both","billing_class":"facility"}]},{"description":"HEP B CORE AB IGM","code_information":[{"code":"16229","type":"CDM"},{"code":"300","type":"RC"},{"code":"86705","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility"}]},{"description":"HEP B SURFACE AB","code_information":[{"code":"16230","type":"CDM"},{"code":"302","type":"RC"},{"code":"86706","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.9,"discounted_cash":29.45,"setting":"both","billing_class":"facility"}]},{"description":"HEP BE AB","code_information":[{"code":"16232","type":"CDM"},{"code":"302","type":"RC"},{"code":"86707","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.65,"discounted_cash":27.32,"setting":"both","billing_class":"facility"}]},{"description":"HEP A AB IGG","code_information":[{"code":"16233","type":"CDM"},{"code":"302","type":"RC"},{"code":"86708","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility"}]},{"description":"HEP C VIRUS/LIV FIBR","code_information":[{"code":"16235","type":"CDM"},{"code":"300","type":"RC"},{"code":"81599","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":633.9,"discounted_cash":316.95,"setting":"both","billing_class":"facility"}]},{"description":"HEP A AB IGM","code_information":[{"code":"16236","type":"CDM"},{"code":"300","type":"RC"},{"code":"86709","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.6,"discounted_cash":23.3,"setting":"both","billing_class":"facility"}]},{"description":"AB INFLUENZA-A","code_information":[{"code":"16237","type":"CDM"},{"code":"300","type":"RC"},{"code":"86710","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":74.35,"discounted_cash":37.17,"setting":"both","billing_class":"facility"}]},{"description":"AB INFLUENZA-B","code_information":[{"code":"16239","type":"CDM"},{"code":"300","type":"RC"},{"code":"86710","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":74.35,"discounted_cash":37.17,"setting":"both","billing_class":"facility"}]},{"description":"MNL DIFF WBC B-COUNT","code_information":[{"code":"16240","type":"CDM"},{"code":"300","type":"RC"},{"code":"85009","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.35,"discounted_cash":27.18,"setting":"both","billing_class":"facility"}]},{"description":"AB LEGIONELLA","code_information":[{"code":"16241","type":"CDM"},{"code":"300","type":"RC"},{"code":"86713","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":123.95,"discounted_cash":61.98,"setting":"both","billing_class":"facility"}]},{"description":"COVID-19 LAB TEST NO","code_information":[{"code":"16242","type":"CDM"},{"code":"300","type":"RC"},{"code":"U0002","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":212.1,"discounted_cash":106.05,"setting":"both","billing_class":"facility"}]},{"description":"NFCT DS CHRNC HCV 6","code_information":[{"code":"16243","type":"CDM"},{"code":"300","type":"RC"},{"code":"81596","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":298.45,"discounted_cash":149.22,"setting":"both","billing_class":"facility"}]},{"description":"SMEAR COMPLEX STAIN","code_information":[{"code":"16244","type":"CDM"},{"code":"306","type":"RC"},{"code":"87209","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":85.75,"discounted_cash":42.88,"setting":"both","billing_class":"facility"}]},{"description":"AGNT NOS ASY W/OPTIC","code_information":[{"code":"16245","type":"CDM"},{"code":"306","type":"RC"},{"code":"87899","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.65,"discounted_cash":38.33,"setting":"both","billing_class":"facility"}]},{"description":"SARS-COV-2 COVID-19","code_information":[{"code":"16247","type":"CDM"},{"code":"306","type":"RC"},{"code":"87635","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.9,"discounted_cash":196.95,"setting":"both","billing_class":"facility"}]},{"description":"MYCOPLASMA PNEUMONIA","code_information":[{"code":"16255","type":"CDM"},{"code":"302","type":"RC"},{"code":"86738","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.25,"discounted_cash":31.63,"setting":"both","billing_class":"facility"}]},{"description":"AB MYCOPLASMA TITER","code_information":[{"code":"16256","type":"CDM"},{"code":"300","type":"RC"},{"code":"86738","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.6,"discounted_cash":36.3,"setting":"both","billing_class":"facility"}]},{"description":"AB PARVOVIRUS IGM","code_information":[{"code":"16257","type":"CDM"},{"code":"300","type":"RC"},{"code":"86747","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility"}]},{"description":"AB PARVOVIRUS IGG","code_information":[{"code":"16258","type":"CDM"},{"code":"300","type":"RC"},{"code":"86747","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":199.95,"discounted_cash":99.97,"setting":"both","billing_class":"facility"}]},{"description":"RUBELLA TITER","code_information":[{"code":"16265","type":"CDM"},{"code":"300","type":"RC"},{"code":"86762","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.95,"discounted_cash":39.48,"setting":"both","billing_class":"facility"}]},{"description":"AB RUBELLA IGM","code_information":[{"code":"16267","type":"CDM"},{"code":"300","type":"RC"},{"code":"86762","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":99.95,"discounted_cash":49.98,"setting":"both","billing_class":"facility"}]},{"description":"RUBEOLA SCREEN","code_information":[{"code":"16268","type":"CDM"},{"code":"300","type":"RC"},{"code":"86765","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.65,"discounted_cash":35.33,"setting":"both","billing_class":"facility"}]},{"description":"RUBEOLA TITER","code_information":[{"code":"16269","type":"CDM"},{"code":"300","type":"RC"},{"code":"86765","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":89.35,"discounted_cash":44.67,"setting":"both","billing_class":"facility"}]},{"description":"AB TOXOPLASMA","code_information":[{"code":"16270","type":"CDM"},{"code":"300","type":"RC"},{"code":"86777","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility"}]},{"description":"AB TOXOPLASMA IGM","code_information":[{"code":"16271","type":"CDM"},{"code":"300","type":"RC"},{"code":"86778","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility"}]},{"description":"TOXOCARA AB, ELISA","code_information":[{"code":"16272","type":"CDM"},{"code":"300","type":"RC"},{"code":"86682","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":113.3,"discounted_cash":56.65,"setting":"both","billing_class":"facility"}]},{"description":"AB FTA","code_information":[{"code":"16273","type":"CDM"},{"code":"300","type":"RC"},{"code":"86780","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.6,"discounted_cash":36.3,"setting":"both","billing_class":"facility"}]},{"description":"AB VARICELLA ZOSTER","code_information":[{"code":"16274","type":"CDM"},{"code":"300","type":"RC"},{"code":"86787","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":98.65,"discounted_cash":49.33,"setting":"both","billing_class":"facility"}]},{"description":"COLORDO TICK FEVR AB","code_information":[{"code":"16276","type":"CDM"},{"code":"300","type":"RC"},{"code":"86790","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.2,"discounted_cash":150.1,"setting":"both","billing_class":"facility"}]},{"description":"AB HTLV II","code_information":[{"code":"16278","type":"CDM"},{"code":"302","type":"RC"},{"code":"86790","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":79.65,"discounted_cash":39.83,"setting":"both","billing_class":"facility"}]},{"description":"AB LEUKOCYTE ID","code_information":[{"code":"16279","type":"CDM"},{"code":"300","type":"RC"},{"code":"86021","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.6,"discounted_cash":41.3,"setting":"both","billing_class":"facility"}]},{"description":"AB THYROGLOBULIN","code_information":[{"code":"16281","type":"CDM"},{"code":"300","type":"RC"},{"code":"86800","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.25,"discounted_cash":43.63,"setting":"both","billing_class":"facility"}]},{"description":"HEP C AB","code_information":[{"code":"16282","type":"CDM"},{"code":"300","type":"RC"},{"code":"86803","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility"}]},{"description":"HEP C AB RIBA","code_information":[{"code":"16283","type":"CDM"},{"code":"300","type":"RC"},{"code":"86804","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility"}]},{"description":"HLA-B27","code_information":[{"code":"16284","type":"CDM"},{"code":"300","type":"RC"},{"code":"86812","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":269.3,"discounted_cash":134.65,"setting":"both","billing_class":"facility"}]},{"description":"HLA CLASS I TYPING","code_information":[{"code":"16285","type":"CDM"},{"code":"301","type":"RC"},{"code":"81374","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":502.7,"discounted_cash":251.35,"setting":"both","billing_class":"facility"}]},{"description":"HLA TYP DR/DQ MULT","code_information":[{"code":"16288","type":"CDM"},{"code":"300","type":"RC"},{"code":"86817","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":424.6,"discounted_cash":212.3,"setting":"both","billing_class":"facility"}]},{"description":"HEAVY METAL QUANT EA","code_information":[{"code":"16289","type":"CDM"},{"code":"301","type":"RC"},{"code":"83018","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":115.15,"discounted_cash":57.58,"setting":"both","billing_class":"facility"}]},{"description":"UNLSTED MOLECULR PTH","code_information":[{"code":"16290","type":"CDM"},{"code":"310","type":"RC"},{"code":"81479","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1129.25,"discounted_cash":564.63,"setting":"both","billing_class":"facility"}]},{"description":"ALKALINE PHSPHTSE HS","code_information":[{"code":"16291","type":"CDM"},{"code":"301","type":"RC"},{"code":"84078","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":43.6,"discounted_cash":21.8,"setting":"both","billing_class":"facility"}]},{"description":"RTH GENE/MOPATH 6","code_information":[{"code":"16292","type":"CDM"},{"code":"310","type":"RC"},{"code":"81405","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1104.9,"discounted_cash":552.45,"setting":"both","billing_class":"facility"}]},{"description":"TRYPSIN","code_information":[{"code":"16293","type":"CDM"},{"code":"301","type":"RC"},{"code":"83520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":39.25,"setting":"both","billing_class":"facility"}]},{"description":"PREGNENOLONE","code_information":[{"code":"16294","type":"CDM"},{"code":"301","type":"RC"},{"code":"84140","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":108.15,"discounted_cash":54.08,"setting":"both","billing_class":"facility"}]},{"description":"MITOCHONDRIA M2 AB","code_information":[{"code":"16295","type":"CDM"},{"code":"301","type":"RC"},{"code":"83520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":39.25,"setting":"both","billing_class":"facility"}]},{"description":"ANTIBODY VIRUS NOT","code_information":[{"code":"16296","type":"CDM"},{"code":"302","type":"RC"},{"code":"86790","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.3,"discounted_cash":86.65,"setting":"both","billing_class":"facility"}]},{"description":"ASSAY OF CADMIUM","code_information":[{"code":"16297","type":"CDM"},{"code":"301","type":"RC"},{"code":"82300","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.1,"discounted_cash":54.55,"setting":"both","billing_class":"facility"}]},{"description":"ADRENAL ANTIBODY","code_information":[{"code":"16298","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.35,"discounted_cash":26.68,"setting":"both","billing_class":"facility"}]},{"description":"VASCLAR ENDOTHLAL GF","code_information":[{"code":"16299","type":"CDM"},{"code":"301","type":"RC"},{"code":"83520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":39.25,"setting":"both","billing_class":"facility"}]},{"description":"MR STAPH DNA AMP PRO","code_information":[{"code":"16300","type":"CDM"},{"code":"306","type":"RC"},{"code":"87641","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":165.4,"discounted_cash":82.7,"setting":"both","billing_class":"facility"}]},{"description":"ELUTION","code_information":[{"code":"16302","type":"CDM"},{"code":"300","type":"RC"},{"code":"86860","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.7,"discounted_cash":124.85,"setting":"both","billing_class":"facility"}]},{"description":"CULT-BLOOD","code_information":[{"code":"16307","type":"CDM"},{"code":"300","type":"RC"},{"code":"87040","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":64.0,"setting":"both","billing_class":"facility"}]},{"description":"CONC CYTOSPOR","code_information":[{"code":"16308","type":"CDM"},{"code":"300","type":"RC"},{"code":"87015","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.65,"discounted_cash":29.32,"setting":"both","billing_class":"facility"}]},{"description":"CULT-STOOL","code_information":[{"code":"16309","type":"CDM"},{"code":"300","type":"RC"},{"code":"87045","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":118.65,"discounted_cash":59.33,"setting":"both","billing_class":"facility"}]},{"description":"CULT THROAT OR NOSE","code_information":[{"code":"16310","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.6,"discounted_cash":53.3,"setting":"both","billing_class":"facility"}]},{"description":"CULT-EAR","code_information":[{"code":"16316","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.6,"discounted_cash":53.3,"setting":"both","billing_class":"facility"}]},{"description":"CULT-ENVIRONMENTAL","code_information":[{"code":"16317","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":142.7,"discounted_cash":71.35,"setting":"both","billing_class":"facility"}]},{"description":"CULT-EYE","code_information":[{"code":"16318","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.6,"discounted_cash":53.3,"setting":"both","billing_class":"facility"}]},{"description":"CULT-CATHETER TIP","code_information":[{"code":"16322","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.6,"discounted_cash":53.3,"setting":"both","billing_class":"facility"}]},{"description":"CULT-CSF","code_information":[{"code":"16324","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":125.3,"discounted_cash":62.65,"setting":"both","billing_class":"facility"}]},{"description":"CULT-NASAL","code_information":[{"code":"16325","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.6,"discounted_cash":53.3,"setting":"both","billing_class":"facility"}]},{"description":"CULT-RESPIRATORY","code_information":[{"code":"16327","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.6,"discounted_cash":53.3,"setting":"both","billing_class":"facility"}]},{"description":"CULT-ROUTINE","code_information":[{"code":"16329","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":44.1,"discounted_cash":22.05,"setting":"both","billing_class":"facility"}]},{"description":"CULT-TISSUE","code_information":[{"code":"16331","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.6,"discounted_cash":53.3,"setting":"both","billing_class":"facility"}]},{"description":"CULT-OTH SOURCE","code_information":[{"code":"16332","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.6,"discounted_cash":53.3,"setting":"both","billing_class":"facility"}]},{"description":"CULT-WOUND/ABSCESS","code_information":[{"code":"16335","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.6,"discounted_cash":53.3,"setting":"both","billing_class":"facility"}]},{"description":"CULT-STERILE BDY FLU","code_information":[{"code":"16336","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.6,"discounted_cash":53.3,"setting":"both","billing_class":"facility"}]},{"description":"CULT-CERVIX/UTERUS","code_information":[{"code":"16337","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":106.6,"discounted_cash":53.3,"setting":"both","billing_class":"facility"}]},{"description":"PRESUMPTIVE ID AEROB","code_information":[{"code":"16338","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.3,"discounted_cash":32.65,"setting":"both","billing_class":"facility"}]},{"description":"CULT ID BY KIT","code_information":[{"code":"16339","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":34.65,"setting":"both","billing_class":"facility"}]},{"description":"CULTURE IDENT EACH","code_information":[{"code":"16341","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.95,"discounted_cash":27.98,"setting":"both","billing_class":"facility"}]},{"description":"CULT-ANAEROBIC","code_information":[{"code":"16347","type":"CDM"},{"code":"300","type":"RC"},{"code":"87075","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":98.65,"discounted_cash":49.33,"setting":"both","billing_class":"facility"}]},{"description":"CULT-ANAEROBIC ID","code_information":[{"code":"16349","type":"CDM"},{"code":"300","type":"RC"},{"code":"87076","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility"}]},{"description":"CULT AEROBIC ID","code_information":[{"code":"16352","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":34.65,"setting":"both","billing_class":"facility"}]},{"description":"CULT-G C","code_information":[{"code":"16355","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":85.3,"discounted_cash":42.65,"setting":"both","billing_class":"facility"}]},{"description":"CULT-GROUP B STREP","code_information":[{"code":"16357","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":52.0,"setting":"both","billing_class":"facility"}]},{"description":"CULTURE-MRSA","code_information":[{"code":"16359","type":"CDM"},{"code":"306","type":"RC"},{"code":"87081","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":52.0,"setting":"both","billing_class":"facility"}]},{"description":"CULT-LEGIONELLA","code_information":[{"code":"16360","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.65,"discounted_cash":65.33,"setting":"both","billing_class":"facility"}]},{"description":"CULT-URINE CC","code_information":[{"code":"16367","type":"CDM"},{"code":"300","type":"RC"},{"code":"87086","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":89.35,"discounted_cash":44.67,"setting":"both","billing_class":"facility"}]},{"description":"CULT- URINE ID","code_information":[{"code":"16369","type":"CDM"},{"code":"300","type":"RC"},{"code":"87088","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility"}]},{"description":"CULT-FUNGUS-OTH","code_information":[{"code":"16371","type":"CDM"},{"code":"300","type":"RC"},{"code":"87102","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":99.95,"discounted_cash":49.98,"setting":"both","billing_class":"facility"}]},{"description":"CULT-FUNGUS-BLOOD","code_information":[{"code":"16372","type":"CDM"},{"code":"300","type":"RC"},{"code":"87103","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.65,"discounted_cash":33.33,"setting":"both","billing_class":"facility"}]},{"description":"CULT-FUNGUS ID","code_information":[{"code":"16373","type":"CDM"},{"code":"300","type":"RC"},{"code":"87106","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.7,"discounted_cash":31.35,"setting":"both","billing_class":"facility"}]},{"description":"CULT-MYCOPLASM/UREAP","code_information":[{"code":"16374","type":"CDM"},{"code":"300","type":"RC"},{"code":"87109","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.65,"discounted_cash":25.32,"setting":"both","billing_class":"facility"}]},{"description":"CULT-CHLAMYDIA","code_information":[{"code":"16375","type":"CDM"},{"code":"300","type":"RC"},{"code":"87110","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.3,"discounted_cash":86.65,"setting":"both","billing_class":"facility"}]},{"description":"CULT-AFB","code_information":[{"code":"16376","type":"CDM"},{"code":"300","type":"RC"},{"code":"87116","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":121.3,"discounted_cash":60.65,"setting":"both","billing_class":"facility"}]},{"description":"MACRO EXAM PARASITE","code_information":[{"code":"16380","type":"CDM"},{"code":"300","type":"RC"},{"code":"87169","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.25,"discounted_cash":28.63,"setting":"both","billing_class":"facility"}]},{"description":"O&P EXAM","code_information":[{"code":"16383","type":"CDM"},{"code":"300","type":"RC"},{"code":"87177","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":139.95,"discounted_cash":69.97,"setting":"both","billing_class":"facility"}]},{"description":"SENS AGAR DIFF EA AB","code_information":[{"code":"16384","type":"CDM"},{"code":"300","type":"RC"},{"code":"87181","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":13.32,"setting":"both","billing_class":"facility"}]},{"description":"SENS  DISK METHOD","code_information":[{"code":"16385","type":"CDM"},{"code":"300","type":"RC"},{"code":"87184","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":51.95,"discounted_cash":25.98,"setting":"both","billing_class":"facility"}]},{"description":"SENS  MIC","code_information":[{"code":"16386","type":"CDM"},{"code":"300","type":"RC"},{"code":"87186","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.65,"discounted_cash":29.32,"setting":"both","billing_class":"facility"}]},{"description":"SMEAR FOR WBCS NONSP","code_information":[{"code":"16390","type":"CDM"},{"code":"300","type":"RC"},{"code":"87205","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.65,"discounted_cash":27.32,"setting":"both","billing_class":"facility"}]},{"description":"GRAM STAIN","code_information":[{"code":"16392","type":"CDM"},{"code":"300","type":"RC"},{"code":"87205","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.7,"discounted_cash":31.35,"setting":"both","billing_class":"facility"}]},{"description":"FUNGUS STAIN","code_information":[{"code":"16394","type":"CDM"},{"code":"300","type":"RC"},{"code":"87206","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.65,"discounted_cash":25.32,"setting":"both","billing_class":"facility"}]},{"description":"CANRENONE SERUM/PLAS","code_information":[{"code":"16395","type":"CDM"},{"code":"301","type":"RC"},{"code":"80299","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":193.95,"discounted_cash":96.97,"setting":"both","billing_class":"facility"}]},{"description":"SMEAR AFB","code_information":[{"code":"16396","type":"CDM"},{"code":"300","type":"RC"},{"code":"87206","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.35,"discounted_cash":30.68,"setting":"both","billing_class":"facility"}]},{"description":"SMEAR MALARIAL","code_information":[{"code":"16398","type":"CDM"},{"code":"300","type":"RC"},{"code":"87207","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.65,"discounted_cash":33.33,"setting":"both","billing_class":"facility"}]},{"description":"SMEAR WET MOUNT","code_information":[{"code":"16404","type":"CDM"},{"code":"300","type":"RC"},{"code":"87210","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility"}]},{"description":"INDIA INK PREP","code_information":[{"code":"16405","type":"CDM"},{"code":"300","type":"RC"},{"code":"87210","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.65,"discounted_cash":27.32,"setting":"both","billing_class":"facility"}]},{"description":"M.PNEUMON DNA AMP PR","code_information":[{"code":"16406","type":"CDM"},{"code":"306","type":"RC"},{"code":"87581","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":156.8,"discounted_cash":78.4,"setting":"both","billing_class":"facility"}]},{"description":"CHYLMD PNEUM DNA AMP","code_information":[{"code":"16407","type":"CDM"},{"code":"306","type":"RC"},{"code":"87486","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":156.8,"discounted_cash":78.4,"setting":"both","billing_class":"facility"}]},{"description":"SMEAR FUNGAL KOH","code_information":[{"code":"16409","type":"CDM"},{"code":"300","type":"RC"},{"code":"87220","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.65,"discounted_cash":15.32,"setting":"both","billing_class":"facility"}]},{"description":"CULT-VIRAL","code_information":[{"code":"16413","type":"CDM"},{"code":"300","type":"RC"},{"code":"87252","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.65,"discounted_cash":133.32,"setting":"both","billing_class":"facility"}]},{"description":"CULT-HERPES","code_information":[{"code":"16414","type":"CDM"},{"code":"300","type":"RC"},{"code":"87252","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":313.25,"discounted_cash":156.63,"setting":"both","billing_class":"facility"}]},{"description":"CULT HEREPES S VIRUS","code_information":[{"code":"16417","type":"CDM"},{"code":"300","type":"RC"},{"code":"87255","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":163.95,"discounted_cash":81.97,"setting":"both","billing_class":"facility"}]},{"description":"LEGIONELLA AG DFA","code_information":[{"code":"16423","type":"CDM"},{"code":"300","type":"RC"},{"code":"87278","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.6,"discounted_cash":75.3,"setting":"both","billing_class":"facility"}]},{"description":"RSV AG DFA","code_information":[{"code":"16424","type":"CDM"},{"code":"300","type":"RC"},{"code":"87280","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":165.25,"discounted_cash":82.63,"setting":"both","billing_class":"facility"}]},{"description":"RESP DFA VIRAL SCRN","code_information":[{"code":"16427","type":"CDM"},{"code":"300","type":"RC"},{"code":"87300","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.65,"discounted_cash":39.33,"setting":"both","billing_class":"facility"}]},{"description":"C  DIFF TOXIN A  EIA","code_information":[{"code":"16429","type":"CDM"},{"code":"300","type":"RC"},{"code":"87324","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":153.3,"discounted_cash":76.65,"setting":"both","billing_class":"facility"}]},{"description":"GIARD/CRYPTO AG EIA","code_information":[{"code":"16432","type":"CDM"},{"code":"300","type":"RC"},{"code":"87328","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility"}]},{"description":"GIARDIA AG EIA","code_information":[{"code":"16433","type":"CDM"},{"code":"300","type":"RC"},{"code":"87329","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility"}]},{"description":"H PYLORI AG","code_information":[{"code":"16436","type":"CDM"},{"code":"300","type":"RC"},{"code":"87338","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":123.95,"discounted_cash":61.98,"setting":"both","billing_class":"facility"}]},{"description":"HEP B SURFACE AG","code_information":[{"code":"16437","type":"CDM"},{"code":"300","type":"RC"},{"code":"87340","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.65,"discounted_cash":47.33,"setting":"both","billing_class":"facility"}]},{"description":"HEP BE AG","code_information":[{"code":"16439","type":"CDM"},{"code":"306","type":"RC"},{"code":"87350","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.65,"discounted_cash":27.32,"setting":"both","billing_class":"facility"}]},{"description":"HISTOPLASMA AG EIA","code_information":[{"code":"16440","type":"CDM"},{"code":"300","type":"RC"},{"code":"87385","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":242.65,"discounted_cash":121.33,"setting":"both","billing_class":"facility"}]},{"description":"INF AGENT CAMPY EIA","code_information":[{"code":"16443","type":"CDM"},{"code":"300","type":"RC"},{"code":"87899","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.35,"discounted_cash":38.67,"setting":"both","billing_class":"facility"}]},{"description":"INF AGENT SHIGA TOX1","code_information":[{"code":"16444","type":"CDM"},{"code":"300","type":"RC"},{"code":"87899","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.35,"discounted_cash":38.67,"setting":"both","billing_class":"facility"}]},{"description":"INF AGENT SHIGA TOX2","code_information":[{"code":"16445","type":"CDM"},{"code":"300","type":"RC"},{"code":"87899","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.35,"discounted_cash":38.67,"setting":"both","billing_class":"facility"}]},{"description":"AB HERPES TYPE I","code_information":[{"code":"16446","type":"CDM"},{"code":"302","type":"RC"},{"code":"86695","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":90.3,"discounted_cash":45.15,"setting":"both","billing_class":"facility"}]},{"description":"CANDIDA ALBCANS AB","code_information":[{"code":"16447","type":"CDM"},{"code":"302","type":"RC"},{"code":"86628","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.3,"discounted_cash":41.15,"setting":"both","billing_class":"facility"}]},{"description":"GLYCOMARK","code_information":[{"code":"16449","type":"CDM"},{"code":"301","type":"RC"},{"code":"84378","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.15,"discounted_cash":26.07,"setting":"both","billing_class":"facility"}]},{"description":"YO ANTIBDY W REFL WB","code_information":[{"code":"16450","type":"CDM"},{"code":"302","type":"RC"},{"code":"86255","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":262.3,"discounted_cash":131.15,"setting":"both","billing_class":"facility"}]},{"description":"RI ANTIBDY W REFL WB","code_information":[{"code":"16451","type":"CDM"},{"code":"302","type":"RC"},{"code":"86255","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":262.3,"discounted_cash":131.15,"setting":"both","billing_class":"facility"}]},{"description":"IODINE","code_information":[{"code":"16452","type":"CDM"},{"code":"301","type":"RC"},{"code":"82542","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.15,"discounted_cash":36.08,"setting":"both","billing_class":"facility"}]},{"description":"BILE ACID","code_information":[{"code":"16454","type":"CDM"},{"code":"301","type":"RC"},{"code":"82239","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.45,"discounted_cash":24.23,"setting":"both","billing_class":"facility"}]},{"description":"INFLU SUB RT PCR 1ST","code_information":[{"code":"16455","type":"CDM"},{"code":"306","type":"RC"},{"code":"87502","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":233.5,"setting":"both","billing_class":"facility"}]},{"description":"INFLU SUB RT PCR ADD","code_information":[{"code":"16456","type":"CDM"},{"code":"306","type":"RC"},{"code":"87503","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility"}]},{"description":"TPMT DRUG/SUBSTANCE","code_information":[{"code":"16457","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":333.35,"discounted_cash":166.68,"setting":"both","billing_class":"facility"}]},{"description":"RESP SYNCYTIAL VIR A","code_information":[{"code":"16458","type":"CDM"},{"code":"306","type":"RC"},{"code":"87420","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.65,"discounted_cash":33.33,"setting":"both","billing_class":"facility"}]},{"description":"INFLU DIRCT OPTCL OB","code_information":[{"code":"16459","type":"CDM"},{"code":"306","type":"RC"},{"code":"87804","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.3,"discounted_cash":41.15,"setting":"both","billing_class":"facility"}]},{"description":"DEXAMETHASONE","code_information":[{"code":"16460","type":"CDM"},{"code":"301","type":"RC"},{"code":"80299","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.65,"discounted_cash":43.33,"setting":"both","billing_class":"facility"}]},{"description":"KIT D816 MUTATION","code_information":[{"code":"16461","type":"CDM"},{"code":"310","type":"RC"},{"code":"81273","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":510.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility"}]},{"description":"NRAS MUTATION","code_information":[{"code":"16462","type":"CDM"},{"code":"310","type":"RC"},{"code":"81311","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":666.6,"discounted_cash":333.3,"setting":"both","billing_class":"facility"}]},{"description":"PCR INFLUENZA A/B","code_information":[{"code":"16463","type":"CDM"},{"code":"300","type":"RC"},{"code":"87631","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":413.3,"discounted_cash":206.65,"setting":"both","billing_class":"facility"}]},{"description":"ROTAVIRUS AG EIA","code_information":[{"code":"16464","type":"CDM"},{"code":"300","type":"RC"},{"code":"87425","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.6,"discounted_cash":43.3,"setting":"both","billing_class":"facility"}]},{"description":"HIV 2 DNA/RNA PCR","code_information":[{"code":"16465","type":"CDM"},{"code":"300","type":"RC"},{"code":"87538","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.55,"discounted_cash":130.78,"setting":"both","billing_class":"facility"}]},{"description":"ENTAMOEBA HISTOLYTIC","code_information":[{"code":"16466","type":"CDM"},{"code":"306","type":"RC"},{"code":"87337","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.65,"discounted_cash":33.33,"setting":"both","billing_class":"facility"}]},{"description":"IGVH MUTATION STATUS","code_information":[{"code":"16467","type":"CDM"},{"code":"310","type":"RC"},{"code":"81263","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1333.25,"discounted_cash":666.63,"setting":"both","billing_class":"facility"}]},{"description":"TREPONEMA PALLADIUM","code_information":[{"code":"16468","type":"CDM"},{"code":"302","type":"RC"},{"code":"86403","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.3,"discounted_cash":54.65,"setting":"both","billing_class":"facility"}]},{"description":"GLUTATHIONE TOTAL","code_information":[{"code":"16469","type":"CDM"},{"code":"300","type":"RC"},{"code":"82978","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility"}]},{"description":"ANTIBODY JC VIRUS","code_information":[{"code":"16470","type":"CDM"},{"code":"300","type":"RC"},{"code":"86711","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":43.0,"setting":"both","billing_class":"facility"}]},{"description":"ALPHA 1 ANTITRYPSIN","code_information":[{"code":"16471","type":"CDM"},{"code":"310","type":"RC"},{"code":"81332","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":233.6,"discounted_cash":116.8,"setting":"both","billing_class":"facility"}]},{"description":"MONONUCLEAR CELL ANT","code_information":[{"code":"16472","type":"CDM"},{"code":"302","type":"RC"},{"code":"86356","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":154.3,"discounted_cash":77.15,"setting":"both","billing_class":"facility"}]},{"description":"SPECTRPHOTOMETRY AN","code_information":[{"code":"16473","type":"CDM"},{"code":"301","type":"RC"},{"code":"84311","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":198.75,"discounted_cash":99.38,"setting":"both","billing_class":"facility"}]},{"description":"INFECT AGENT AG NOS","code_information":[{"code":"16474","type":"CDM"},{"code":"300","type":"RC"},{"code":"87449","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility"}]},{"description":"CLMN CHROMATGRPH NDE","code_information":[{"code":"16475","type":"CDM"},{"code":"301","type":"RC"},{"code":"82542","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.05,"discounted_cash":63.02,"setting":"both","billing_class":"facility"}]},{"description":"CANNABINOIDS NATURAL","code_information":[{"code":"16476","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.9,"discounted_cash":30.45,"setting":"both","billing_class":"facility"}]},{"description":"SPECIFIC GRVTY NOT U","code_information":[{"code":"16477","type":"CDM"},{"code":"301","type":"RC"},{"code":"84315","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":12.13,"setting":"both","billing_class":"facility"}]},{"description":"OSMOTIC FRAGLTY RBC","code_information":[{"code":"16478","type":"CDM"},{"code":"305","type":"RC"},{"code":"85557","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.45,"discounted_cash":35.23,"setting":"both","billing_class":"facility"}]},{"description":"INFECT AGT DETECT NA","code_information":[{"code":"16479","type":"CDM"},{"code":"306","type":"RC"},{"code":"87533","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":216.65,"discounted_cash":108.33,"setting":"both","billing_class":"facility"}]},{"description":"C DIFF AMPLIFIED PRB","code_information":[{"code":"16480","type":"CDM"},{"code":"306","type":"RC"},{"code":"87493","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":181.95,"discounted_cash":90.97,"setting":"both","billing_class":"facility"}]},{"description":"KIT GENE TARGET SEQ","code_information":[{"code":"16481","type":"CDM"},{"code":"310","type":"RC"},{"code":"81272","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1208.25,"discounted_cash":604.13,"setting":"both","billing_class":"facility"}]},{"description":"ALLERGEN SPEC IGE QN","code_information":[{"code":"16482","type":"CDM"},{"code":"302","type":"RC"},{"code":"86008","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":99.7,"discounted_cash":49.85,"setting":"both","billing_class":"facility"}]},{"description":"ALLERGEN IGE EA","code_information":[{"code":"16483","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.35,"discounted_cash":18.18,"setting":"both","billing_class":"facility"}]},{"description":"LEGIONELLA AG EIA","code_information":[{"code":"16484","type":"CDM"},{"code":"300","type":"RC"},{"code":"87449","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.75,"discounted_cash":32.88,"setting":"both","billing_class":"facility"}]},{"description":"C  DIFFICILE TOXIN B","code_information":[{"code":"16487","type":"CDM"},{"code":"300","type":"RC"},{"code":"87449","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":117.35,"discounted_cash":58.67,"setting":"both","billing_class":"facility"}]},{"description":"LYME DISEASE","code_information":[{"code":"16489","type":"CDM"},{"code":"300","type":"RC"},{"code":"87801","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":551.95,"discounted_cash":275.98,"setting":"both","billing_class":"facility"}]},{"description":"CHLAMYDIA PROBE","code_information":[{"code":"16490","type":"CDM"},{"code":"300","type":"RC"},{"code":"87490","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":117.35,"discounted_cash":58.67,"setting":"both","billing_class":"facility"}]},{"description":"CMV DNA PCR","code_information":[{"code":"16491","type":"CDM"},{"code":"300","type":"RC"},{"code":"87496","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":146.65,"discounted_cash":73.33,"setting":"both","billing_class":"facility"}]},{"description":"CMV QUANT","code_information":[{"code":"16492","type":"CDM"},{"code":"300","type":"RC"},{"code":"87497","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility"}]},{"description":"HEP C RNA PRB PCR QL","code_information":[{"code":"16493","type":"CDM"},{"code":"300","type":"RC"},{"code":"87521","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":374.65,"discounted_cash":187.32,"setting":"both","billing_class":"facility"}]},{"description":"HEP C RNA PRB PCR QT","code_information":[{"code":"16494","type":"CDM"},{"code":"300","type":"RC"},{"code":"87522","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":873.25,"discounted_cash":436.63,"setting":"both","billing_class":"facility"}]},{"description":"HEP C VIRAL RNA GTYP","code_information":[{"code":"16495","type":"CDM"},{"code":"300","type":"RC"},{"code":"87522","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.65,"discounted_cash":101.33,"setting":"both","billing_class":"facility"}]},{"description":"HERPES VIR PCR","code_information":[{"code":"16497","type":"CDM"},{"code":"300","type":"RC"},{"code":"87529","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":197.3,"discounted_cash":98.65,"setting":"both","billing_class":"facility"}]},{"description":"HIV-1 PROBE  PCR","code_information":[{"code":"16499","type":"CDM"},{"code":"306","type":"RC"},{"code":"87535","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":156.4,"discounted_cash":78.2,"setting":"both","billing_class":"facility"}]},{"description":"HIV-1 VIRAL LOAD","code_information":[{"code":"16500","type":"CDM"},{"code":"300","type":"RC"},{"code":"87536","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":578.6,"discounted_cash":289.3,"setting":"both","billing_class":"facility"}]},{"description":"M.TUBERCULO DNA AMP","code_information":[{"code":"16502","type":"CDM"},{"code":"306","type":"RC"},{"code":"87556","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":177.25,"discounted_cash":88.63,"setting":"both","billing_class":"facility"}]},{"description":"GC PROBE","code_information":[{"code":"16505","type":"CDM"},{"code":"300","type":"RC"},{"code":"87590","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":159.95,"discounted_cash":79.97,"setting":"both","billing_class":"facility"}]},{"description":"GC AMP PROBE","code_information":[{"code":"16506","type":"CDM"},{"code":"306","type":"RC"},{"code":"87591","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.6,"discounted_cash":75.3,"setting":"both","billing_class":"facility"}]},{"description":"CHLAMYDIA AMP PROBE","code_information":[{"code":"16507","type":"CDM"},{"code":"306","type":"RC"},{"code":"87491","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":192.5,"discounted_cash":96.25,"setting":"both","billing_class":"facility"}]},{"description":"CHLAM/GC/TRICHOMONAS","code_information":[{"code":"16508","type":"CDM"},{"code":"306","type":"RC"},{"code":"87491","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":421.3,"discounted_cash":210.65,"setting":"both","billing_class":"facility"}]},{"description":"RESP VIRUS 12-25 TAR","code_information":[{"code":"16511","type":"CDM"},{"code":"306","type":"RC"},{"code":"87633","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1403.85,"discounted_cash":701.92,"setting":"both","billing_class":"facility"}]},{"description":"TRICHOMONAS TMA","code_information":[{"code":"16512","type":"CDM"},{"code":"306","type":"RC"},{"code":"87661","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":297.3,"discounted_cash":148.65,"setting":"both","billing_class":"facility"}]},{"description":"TOXOPLSM GONDII DNA","code_information":[{"code":"16514","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":248.0,"setting":"both","billing_class":"facility"}]},{"description":"EHRLCHA CHFFNNSS DNA","code_information":[{"code":"16515","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":507.95,"discounted_cash":253.97,"setting":"both","billing_class":"facility"}]},{"description":"MICROBIAL PROBE PCR","code_information":[{"code":"16516","type":"CDM"},{"code":"306","type":"RC"},{"code":"87798","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":192.5,"discounted_cash":96.25,"setting":"both","billing_class":"facility"}]},{"description":"VARICELLA ZOSTER PCR","code_information":[{"code":"16517","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.95,"discounted_cash":89.97,"setting":"both","billing_class":"facility"}]},{"description":"MUMPS, VIRUS","code_information":[{"code":"16518","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":250.65,"discounted_cash":125.33,"setting":"both","billing_class":"facility"}]},{"description":"PARVOVIRUS PCR","code_information":[{"code":"16519","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":318.6,"discounted_cash":159.3,"setting":"both","billing_class":"facility"}]},{"description":"EBV QUANT","code_information":[{"code":"16520","type":"CDM"},{"code":"300","type":"RC"},{"code":"87799","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":159.95,"discounted_cash":79.97,"setting":"both","billing_class":"facility"}]},{"description":"BK QUANT","code_information":[{"code":"16522","type":"CDM"},{"code":"300","type":"RC"},{"code":"87799","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":477.25,"discounted_cash":238.63,"setting":"both","billing_class":"facility"}]},{"description":"GC/CHLAMYDIA DNA","code_information":[{"code":"16523","type":"CDM"},{"code":"300","type":"RC"},{"code":"87800","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":222.65,"discounted_cash":111.33,"setting":"both","billing_class":"facility"}]},{"description":"HBV RX RESIST GEN TP","code_information":[{"code":"16525","type":"CDM"},{"code":"300","type":"RC"},{"code":"87912","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":970.6,"discounted_cash":485.3,"setting":"both","billing_class":"facility"}]},{"description":"T-SPOT TB","code_information":[{"code":"16526","type":"CDM"},{"code":"300","type":"RC"},{"code":"86481","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":366.6,"discounted_cash":183.3,"setting":"both","billing_class":"facility"}]},{"description":"PML-RARA","code_information":[{"code":"16527","type":"CDM"},{"code":"300","type":"RC"},{"code":"81315","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":813.25,"discounted_cash":406.63,"setting":"both","billing_class":"facility"}]},{"description":"IGG SUBCLASS 4","code_information":[{"code":"16528","type":"CDM"},{"code":"300","type":"RC"},{"code":"82787","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility"}]},{"description":"CYSTINE, 24 HR URINE","code_information":[{"code":"16529","type":"CDM"},{"code":"300","type":"RC"},{"code":"82131","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.55,"discounted_cash":27.27,"setting":"both","billing_class":"facility"}]},{"description":"CYTOLOGY FLUIDS","code_information":[{"code":"16531","type":"CDM"},{"code":"310","type":"RC"},{"code":"88104","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":255.95,"discounted_cash":127.97,"setting":"both","billing_class":"facility"}]},{"description":"CYTOSPIN W/SMEAR","code_information":[{"code":"16534","type":"CDM"},{"code":"310","type":"RC"},{"code":"88108","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":174.75,"discounted_cash":87.38,"setting":"both","billing_class":"facility"}]},{"description":"CYTO NONGYN ENH TECH","code_information":[{"code":"16535","type":"CDM"},{"code":"310","type":"RC"},{"code":"88112","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":195.65,"discounted_cash":97.83,"setting":"both","billing_class":"facility"}]},{"description":"PAP-THIN PREP DIAG","code_information":[{"code":"16537","type":"CDM"},{"code":"310","type":"RC"},{"code":"88142","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.55,"discounted_cash":60.27,"setting":"both","billing_class":"facility"}]},{"description":"CYTO EXM INT SITE","code_information":[{"code":"16541","type":"CDM"},{"code":"311","type":"RC"},{"code":"88333","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":995.6,"discounted_cash":497.8,"setting":"both","billing_class":"facility"}]},{"description":"CYTO EX ADD SITE","code_information":[{"code":"16542","type":"CDM"},{"code":"300","type":"RC"},{"code":"88334","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":118.1,"discounted_cash":59.05,"setting":"both","billing_class":"facility"}]},{"description":"CYTOLOGY SMEAR W/PRE","code_information":[{"code":"16545","type":"CDM"},{"code":"310","type":"RC"},{"code":"88161","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":162.4,"discounted_cash":81.2,"setting":"both","billing_class":"facility"}]},{"description":"FNA EVALUATION","code_information":[{"code":"16549","type":"CDM"},{"code":"310","type":"RC"},{"code":"88172","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":239.95,"discounted_cash":119.97,"setting":"both","billing_class":"facility"}]},{"description":"FNA INTERP & REPORT","code_information":[{"code":"16550","type":"CDM"},{"code":"310","type":"RC"},{"code":"88173","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":255.95,"discounted_cash":127.97,"setting":"both","billing_class":"facility"}]},{"description":"TISSUE CULT-LYMPHCYT","code_information":[{"code":"16558","type":"CDM"},{"code":"311","type":"RC"},{"code":"88230","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":444.85,"discounted_cash":222.43,"setting":"both","billing_class":"facility"}]},{"description":"CHROM ANALYSIS 20-25","code_information":[{"code":"16564","type":"CDM"},{"code":"310","type":"RC"},{"code":"88264","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":363.6,"discounted_cash":181.8,"setting":"both","billing_class":"facility"}]},{"description":"FISH AML M3 PML/RARA","code_information":[{"code":"16566","type":"CDM"},{"code":"310","type":"RC"},{"code":"88275","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":642.4,"discounted_cash":321.2,"setting":"both","billing_class":"facility"}]},{"description":"FISH HGLP","code_information":[{"code":"16568","type":"CDM"},{"code":"311","type":"RC"},{"code":"88271","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1833.55,"discounted_cash":916.77,"setting":"both","billing_class":"facility"}]},{"description":"MOLECULR CYTO DNA PR","code_information":[{"code":"16571","type":"CDM"},{"code":"310","type":"RC"},{"code":"88271","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":206.05,"discounted_cash":103.03,"setting":"both","billing_class":"facility"}]},{"description":"MOLECULAR CYTO ISH","code_information":[{"code":"16572","type":"CDM"},{"code":"310","type":"RC"},{"code":"88274","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":496.9,"discounted_cash":248.45,"setting":"both","billing_class":"facility"}]},{"description":"INTRPHS ISH 100-300C","code_information":[{"code":"16573","type":"CDM"},{"code":"310","type":"RC"},{"code":"88275","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":203.6,"discounted_cash":101.8,"setting":"both","billing_class":"facility"}]},{"description":"CHROM TST ADD KRYOTP","code_information":[{"code":"16574","type":"CDM"},{"code":"310","type":"RC"},{"code":"88280","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":149.1,"discounted_cash":74.55,"setting":"both","billing_class":"facility"}]},{"description":"SURG PATH  LEV I","code_information":[{"code":"16577","type":"CDM"},{"code":"310","type":"RC"},{"code":"88300","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.15,"discounted_cash":51.08,"setting":"both","billing_class":"facility"}]},{"description":"SURG PATH  LEV II","code_information":[{"code":"16578","type":"CDM"},{"code":"310","type":"RC"},{"code":"88302","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":174.75,"discounted_cash":87.38,"setting":"both","billing_class":"facility"}]},{"description":"SURG PATH  LEV III","code_information":[{"code":"16579","type":"CDM"},{"code":"310","type":"RC"},{"code":"88304","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":239.95,"discounted_cash":119.97,"setting":"both","billing_class":"facility"}]},{"description":"SURG PATH  LEV IV","code_information":[{"code":"16580","type":"CDM"},{"code":"310","type":"RC"},{"code":"88305","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":305.2,"discounted_cash":152.6,"setting":"both","billing_class":"facility"}]},{"description":"SURG PATH  LEV V","code_information":[{"code":"16581","type":"CDM"},{"code":"310","type":"RC"},{"code":"88307","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":450.4,"discounted_cash":225.2,"setting":"both","billing_class":"facility"}]},{"description":"SURG PATH  LEV VI","code_information":[{"code":"16582","type":"CDM"},{"code":"310","type":"RC"},{"code":"88309","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.8,"discounted_cash":370.4,"setting":"both","billing_class":"facility"}]},{"description":"DECALCIFICATION","code_information":[{"code":"16583","type":"CDM"},{"code":"310","type":"RC"},{"code":"88311","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.6,"discounted_cash":52.3,"setting":"both","billing_class":"facility"}]},{"description":"SPC STAINS  GROUP I","code_information":[{"code":"16584","type":"CDM"},{"code":"310","type":"RC"},{"code":"88312","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":69.5,"setting":"both","billing_class":"facility"}]},{"description":"SPC STAINS  GROUP II","code_information":[{"code":"16585","type":"CDM"},{"code":"310","type":"RC"},{"code":"88313","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":113.25,"discounted_cash":56.63,"setting":"both","billing_class":"facility"}]},{"description":"PATH CON W/FRZN SECT","code_information":[{"code":"16588","type":"CDM"},{"code":"310","type":"RC"},{"code":"88331","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":238.7,"discounted_cash":119.35,"setting":"both","billing_class":"facility"}]},{"description":"PATH CON ADDL FROZ","code_information":[{"code":"16589","type":"CDM"},{"code":"310","type":"RC"},{"code":"88332","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":89.8,"discounted_cash":44.9,"setting":"both","billing_class":"facility"}]},{"description":"PD-L1 LUNG IHC","code_information":[{"code":"16590","type":"CDM"},{"code":"310","type":"RC"},{"code":"88342","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":830.65,"discounted_cash":415.32,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNOCYTOCHEM EA AB","code_information":[{"code":"16591","type":"CDM"},{"code":"310","type":"RC"},{"code":"88342","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":514.45,"discounted_cash":257.23,"setting":"both","billing_class":"facility"}]},{"description":"IMMUNOCYTOCHEM ADDTL","code_information":[{"code":"16592","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":217.8,"discounted_cash":108.9,"setting":"both","billing_class":"facility"}]},{"description":"ANDROGEN RECEPTOR","code_information":[{"code":"16593","type":"CDM"},{"code":"310","type":"RC"},{"code":"88342","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":514.45,"discounted_cash":257.23,"setting":"both","billing_class":"facility"}]},{"description":"MORPHOMETRIC QT MAN","code_information":[{"code":"16597","type":"CDM"},{"code":"310","type":"RC"},{"code":"88360","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":514.45,"discounted_cash":257.23,"setting":"both","billing_class":"facility"}]},{"description":"HER2NU MANUAL","code_information":[{"code":"16598","type":"CDM"},{"code":"310","type":"RC"},{"code":"88368","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":927.9,"discounted_cash":463.95,"setting":"both","billing_class":"facility"}]},{"description":"BODY FLUID CELL CT","code_information":[{"code":"16599","type":"CDM"},{"code":"300","type":"RC"},{"code":"89051","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.45,"discounted_cash":13.72,"setting":"both","billing_class":"facility"}]},{"description":"BF CELL CT W/DIFF","code_information":[{"code":"16600","type":"CDM"},{"code":"300","type":"RC"},{"code":"89051","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":35.15,"setting":"both","billing_class":"facility"}]},{"description":"CRYSTALS-BODY FLUID","code_information":[{"code":"16601","type":"CDM"},{"code":"300","type":"RC"},{"code":"89060","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.8,"discounted_cash":19.4,"setting":"both","billing_class":"facility"}]},{"description":"FAT ST-FECES UR/SPUT","code_information":[{"code":"16602","type":"CDM"},{"code":"300","type":"RC"},{"code":"89125","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":15.15,"setting":"both","billing_class":"facility"}]},{"description":"NASAL SMEAR FOR EOS","code_information":[{"code":"16603","type":"CDM"},{"code":"300","type":"RC"},{"code":"89190","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":15.15,"setting":"both","billing_class":"facility"}]},{"description":"SEMEN ANAL COMPLETE","code_information":[{"code":"16608","type":"CDM"},{"code":"300","type":"RC"},{"code":"89320","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":136.95,"discounted_cash":68.47,"setting":"both","billing_class":"facility"}]},{"description":"VENIPUNCTURE <3YRS","code_information":[{"code":"16613","type":"CDM"},{"code":"300","type":"RC"},{"code":"36406","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.1,"discounted_cash":14.55,"setting":"both","billing_class":"facility"}]},{"description":"VENIPUNCTURE","code_information":[{"code":"16614","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":14.65,"setting":"both","billing_class":"facility"}]},{"description":"CAPILLARY PUNCTURE","code_information":[{"code":"16615","type":"CDM"},{"code":"300","type":"RC"},{"code":"36416","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":7.97,"setting":"both","billing_class":"facility"}]},{"description":"ARTERIAL PUNCTURE","code_information":[{"code":"16616","type":"CDM"},{"code":"300","type":"RC"},{"code":"36600","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.55,"discounted_cash":118.78,"setting":"both","billing_class":"facility"}]},{"description":"HEMOGLOBIN ROSETTE","code_information":[{"code":"16621","type":"CDM"},{"code":"300","type":"RC"},{"code":"85461","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.7,"discounted_cash":23.35,"setting":"both","billing_class":"facility"}]},{"description":"KLEIHAUER-BETKE STAI","code_information":[{"code":"16622","type":"CDM"},{"code":"300","type":"RC"},{"code":"85460","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":117.55,"discounted_cash":58.77,"setting":"both","billing_class":"facility"}]},{"description":"TOPIRAMATE","code_information":[{"code":"16623","type":"CDM"},{"code":"300","type":"RC"},{"code":"80201","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.45,"discounted_cash":44.23,"setting":"both","billing_class":"facility"}]},{"description":"TRYPSIN  FECES  QUAL","code_information":[{"code":"16635","type":"CDM"},{"code":"300","type":"RC"},{"code":"84488","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":35.75,"setting":"both","billing_class":"facility"}]},{"description":"PLASMNOGEN","code_information":[{"code":"16637","type":"CDM"},{"code":"300","type":"RC"},{"code":"85420","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.55,"discounted_cash":34.77,"setting":"both","billing_class":"facility"}]},{"description":"AB HELMINTH NOS","code_information":[{"code":"16642","type":"CDM"},{"code":"300","type":"RC"},{"code":"86682","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.3,"discounted_cash":36.65,"setting":"both","billing_class":"facility"}]},{"description":"AB INSULIN","code_information":[{"code":"16643","type":"CDM"},{"code":"300","type":"RC"},{"code":"86337","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":137.3,"discounted_cash":68.65,"setting":"both","billing_class":"facility"}]},{"description":"AB ISLET CELL","code_information":[{"code":"16644","type":"CDM"},{"code":"300","type":"RC"},{"code":"86341","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility"}]},{"description":"ZINC TRANSPORTR 8 AB","code_information":[{"code":"16645","type":"CDM"},{"code":"300","type":"RC"},{"code":"86341","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":267.95,"discounted_cash":133.97,"setting":"both","billing_class":"facility"}]},{"description":"LEPTOSPRA AB W/REFLX","code_information":[{"code":"16647","type":"CDM"},{"code":"300","type":"RC"},{"code":"86720","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":146.65,"discounted_cash":73.33,"setting":"both","billing_class":"facility"}]},{"description":"ANTIBODY PROTOZOA","code_information":[{"code":"16649","type":"CDM"},{"code":"302","type":"RC"},{"code":"86753","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":241.3,"discounted_cash":120.65,"setting":"both","billing_class":"facility"}]},{"description":"AB TETANUS","code_information":[{"code":"16650","type":"CDM"},{"code":"300","type":"RC"},{"code":"86774","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":34.65,"setting":"both","billing_class":"facility"}]},{"description":"SMEAR INTRACELL PARA","code_information":[{"code":"16653","type":"CDM"},{"code":"300","type":"RC"},{"code":"87207","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.65,"discounted_cash":33.33,"setting":"both","billing_class":"facility"}]},{"description":"METHEMOGLOBIN  QUANT","code_information":[{"code":"16661","type":"CDM"},{"code":"300","type":"RC"},{"code":"83050","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.8,"discounted_cash":19.4,"setting":"both","billing_class":"facility"}]},{"description":"MYELN ASSC GLYCPT AB","code_information":[{"code":"16663","type":"CDM"},{"code":"300","type":"RC"},{"code":"84181","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.8,"discounted_cash":130.9,"setting":"both","billing_class":"facility"}]},{"description":"AMPHETAMNES QUANT","code_information":[{"code":"16664","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":187.85,"discounted_cash":93.92,"setting":"both","billing_class":"facility"}]},{"description":"MULTIPLEX IHC STAIN","code_information":[{"code":"16667","type":"CDM"},{"code":"310","type":"RC"},{"code":"88344","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":579.65,"discounted_cash":289.82,"setting":"both","billing_class":"facility"}]},{"description":"GLUCOSE DEVICE","code_information":[{"code":"16669","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.35,"discounted_cash":9.68,"setting":"both","billing_class":"facility"}]},{"description":"GLUC HOME DEV REP","code_information":[{"code":"16670","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.6,"discounted_cash":10.3,"setting":"both","billing_class":"facility"}]},{"description":"PHENYTOIN FREE","code_information":[{"code":"16673","type":"CDM"},{"code":"300","type":"RC"},{"code":"80186","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":89.65,"discounted_cash":44.83,"setting":"both","billing_class":"facility"}]},{"description":"FETAL FIBRONECTIN","code_information":[{"code":"16682","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":631.45,"discounted_cash":315.73,"setting":"both","billing_class":"facility"}]},{"description":"HISTAMNE","code_information":[{"code":"16684","type":"CDM"},{"code":"300","type":"RC"},{"code":"83088","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.9,"discounted_cash":105.45,"setting":"both","billing_class":"facility"}]},{"description":"CORTICOSTERDS 17-OH","code_information":[{"code":"16685","type":"CDM"},{"code":"300","type":"RC"},{"code":"83491","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.55,"discounted_cash":38.77,"setting":"both","billing_class":"facility"}]},{"description":"NMR LIPOPRFL LIPOMED","code_information":[{"code":"16688","type":"CDM"},{"code":"300","type":"RC"},{"code":"83704","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":157.4,"discounted_cash":78.7,"setting":"both","billing_class":"facility"}]},{"description":"NICOTINE","code_information":[{"code":"16691","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":212.1,"discounted_cash":106.05,"setting":"both","billing_class":"facility"}]},{"description":"NEUROMYELITIS OPTICA","code_information":[{"code":"16693","type":"CDM"},{"code":"302","type":"RC"},{"code":"86255","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.65,"discounted_cash":41.33,"setting":"both","billing_class":"facility"}]},{"description":"PROSTAGLANDIN EACH","code_information":[{"code":"16694","type":"CDM"},{"code":"301","type":"RC"},{"code":"84150","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.85,"discounted_cash":75.92,"setting":"both","billing_class":"facility"}]},{"description":"SIALIC ACID/ LASA","code_information":[{"code":"16697","type":"CDM"},{"code":"301","type":"RC"},{"code":"84275","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":33.5,"setting":"both","billing_class":"facility"}]},{"description":"TRYPSIN FECES QT 24H","code_information":[{"code":"16698","type":"CDM"},{"code":"300","type":"RC"},{"code":"84490","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.6,"discounted_cash":25.3,"setting":"both","billing_class":"facility"}]},{"description":"CULT-FUNGUS-SKIN","code_information":[{"code":"16699","type":"CDM"},{"code":"300","type":"RC"},{"code":"87101","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":89.35,"discounted_cash":44.67,"setting":"both","billing_class":"facility"}]},{"description":"HEP B DNA QT BY NA","code_information":[{"code":"16701","type":"CDM"},{"code":"300","type":"RC"},{"code":"87517","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":214.6,"discounted_cash":107.3,"setting":"both","billing_class":"facility"}]},{"description":"CYTOGEN TISS CULT-BM","code_information":[{"code":"16702","type":"CDM"},{"code":"311","type":"RC"},{"code":"88237","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":494.5,"discounted_cash":247.25,"setting":"both","billing_class":"facility"}]},{"description":"HRDROXYPROLINE,PLASM","code_information":[{"code":"16710","type":"CDM"},{"code":"300","type":"RC"},{"code":"83500","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":236.35,"discounted_cash":118.17,"setting":"both","billing_class":"facility"}]},{"description":"VIP","code_information":[{"code":"16712","type":"CDM"},{"code":"300","type":"RC"},{"code":"84586","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":216.95,"discounted_cash":108.47,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR VIII REL AG","code_information":[{"code":"16721","type":"CDM"},{"code":"305","type":"RC"},{"code":"85244","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.35,"discounted_cash":48.17,"setting":"both","billing_class":"facility"}]},{"description":"FCT VIII VW RISTOCET","code_information":[{"code":"16722","type":"CDM"},{"code":"300","type":"RC"},{"code":"85245","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":184.6,"discounted_cash":92.3,"setting":"both","billing_class":"facility"}]},{"description":"DRUG SRN COCAINE","code_information":[{"code":"16723","type":"CDM"},{"code":"301","type":"RC"},{"code":"80353","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.15,"discounted_cash":29.07,"setting":"both","billing_class":"facility"}]},{"description":"GENOTYPE CYTOMEGALOV","code_information":[{"code":"16724","type":"CDM"},{"code":"300","type":"RC"},{"code":"87910","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.1,"discounted_cash":450.55,"setting":"both","billing_class":"facility"}]},{"description":"FCT VIII VW AG","code_information":[{"code":"16725","type":"CDM"},{"code":"300","type":"RC"},{"code":"85246","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":121.4,"discounted_cash":60.7,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR XIII FIBRIN","code_information":[{"code":"16726","type":"CDM"},{"code":"300","type":"RC"},{"code":"85290","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.05,"discounted_cash":36.02,"setting":"both","billing_class":"facility"}]},{"description":"FACTOR XIII, SCRN SO","code_information":[{"code":"16727","type":"CDM"},{"code":"300","type":"RC"},{"code":"85291","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.3,"discounted_cash":36.65,"setting":"both","billing_class":"facility"}]},{"description":"PLATELET AGGREGATION","code_information":[{"code":"16732","type":"CDM"},{"code":"300","type":"RC"},{"code":"85576","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":128.95,"discounted_cash":64.47,"setting":"both","billing_class":"facility"}]},{"description":"ENDOTOX BACT CHEM","code_information":[{"code":"16744","type":"CDM"},{"code":"300","type":"RC"},{"code":"87176","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.65,"discounted_cash":19.32,"setting":"both","billing_class":"facility"}]},{"description":"CHROMIUM","code_information":[{"code":"16748","type":"CDM"},{"code":"300","type":"RC"},{"code":"82495","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":105.85,"discounted_cash":52.92,"setting":"both","billing_class":"facility"}]},{"description":"HGB CHROMATOGRAPHY","code_information":[{"code":"16752","type":"CDM"},{"code":"301","type":"RC"},{"code":"83021","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.05,"discounted_cash":43.02,"setting":"both","billing_class":"facility"}]},{"description":"HOMOVANILLIC ACID (H","code_information":[{"code":"16753","type":"CDM"},{"code":"300","type":"RC"},{"code":"83150","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.95,"discounted_cash":48.48,"setting":"both","billing_class":"facility"}]},{"description":"ESR AUTOMATED","code_information":[{"code":"16756","type":"CDM"},{"code":"305","type":"RC"},{"code":"85652","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.9,"discounted_cash":6.95,"setting":"both","billing_class":"facility"}]},{"description":"FANCC GENE","code_information":[{"code":"16757","type":"CDM"},{"code":"300","type":"RC"},{"code":"81242","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":163.55,"discounted_cash":81.78,"setting":"both","billing_class":"facility"}]},{"description":"IA TUMOR ANTIGEN","code_information":[{"code":"16758","type":"CDM"},{"code":"300","type":"RC"},{"code":"86316","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":113.3,"discounted_cash":56.65,"setting":"both","billing_class":"facility"}]},{"description":"BLM GENE","code_information":[{"code":"16759","type":"CDM"},{"code":"300","type":"RC"},{"code":"81209","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":175.6,"discounted_cash":87.8,"setting":"both","billing_class":"facility"}]},{"description":"GBA GENE","code_information":[{"code":"16760","type":"CDM"},{"code":"300","type":"RC"},{"code":"81251","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":211.05,"discounted_cash":105.53,"setting":"both","billing_class":"facility"}]},{"description":"IKBKAP GENE","code_information":[{"code":"16761","type":"CDM"},{"code":"300","type":"RC"},{"code":"81260","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":175.6,"discounted_cash":87.8,"setting":"both","billing_class":"facility"}]},{"description":"SMPD1 GENE COMMON VR","code_information":[{"code":"16762","type":"CDM"},{"code":"300","type":"RC"},{"code":"81330","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.75,"discounted_cash":104.88,"setting":"both","billing_class":"facility"}]},{"description":"MCOLN1 GENE","code_information":[{"code":"16763","type":"CDM"},{"code":"300","type":"RC"},{"code":"81290","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":175.6,"discounted_cash":87.8,"setting":"both","billing_class":"facility"}]},{"description":"GTT-ADDED SAMPLES","code_information":[{"code":"16764","type":"CDM"},{"code":"301","type":"RC"},{"code":"82952","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.95,"discounted_cash":9.97,"setting":"both","billing_class":"facility"}]},{"description":"TP53 GENE TRGT SQNCE","code_information":[{"code":"16765","type":"CDM"},{"code":"310","type":"RC"},{"code":"81352","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1155.25,"discounted_cash":577.63,"setting":"both","billing_class":"facility"}]},{"description":"ASSAY OF NICKEL","code_information":[{"code":"16766","type":"CDM"},{"code":"301","type":"RC"},{"code":"83885","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.45,"discounted_cash":54.73,"setting":"both","billing_class":"facility"}]},{"description":"MSH6 GENE KNOWN VARI","code_information":[{"code":"16767","type":"CDM"},{"code":"300","type":"RC"},{"code":"81299","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2494.8,"discounted_cash":1247.4,"setting":"both","billing_class":"facility"}]},{"description":"AB ENTEROVIRUS","code_information":[{"code":"16768","type":"CDM"},{"code":"302","type":"RC"},{"code":"86658","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.3,"discounted_cash":40.15,"setting":"both","billing_class":"facility"}]},{"description":"ASSY TEST BLOODFECAL","code_information":[{"code":"16770","type":"CDM"},{"code":"301","type":"RC"},{"code":"82274","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.1,"discounted_cash":38.05,"setting":"both","billing_class":"facility"}]},{"description":"ASSAY OF OSTEOCALCIN","code_information":[{"code":"16771","type":"CDM"},{"code":"301","type":"RC"},{"code":"83937","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":133.35,"discounted_cash":66.67,"setting":"both","billing_class":"facility"}]},{"description":"CFTR GENE FULL SEQNC","code_information":[{"code":"16772","type":"CDM"},{"code":"310","type":"RC"},{"code":"81223","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1749.55,"discounted_cash":874.77,"setting":"both","billing_class":"facility"}]},{"description":"ORGANIC ACIDS QUAL E","code_information":[{"code":"16773","type":"CDM"},{"code":"301","type":"RC"},{"code":"83919","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.05,"discounted_cash":37.52,"setting":"both","billing_class":"facility"}]},{"description":"PINWORM EXAM","code_information":[{"code":"16774","type":"CDM"},{"code":"306","type":"RC"},{"code":"87172","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility"}]},{"description":"ASSAY OF FECES PORPH","code_information":[{"code":"16775","type":"CDM"},{"code":"301","type":"RC"},{"code":"84126","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":166.4,"discounted_cash":83.2,"setting":"both","billing_class":"facility"}]},{"description":"DRUG ASSAY POSACONAZ","code_information":[{"code":"16776","type":"CDM"},{"code":"301","type":"RC"},{"code":"80187","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":115.25,"discounted_cash":57.63,"setting":"both","billing_class":"facility"}]},{"description":"ONCO (OVAR) TWO PROT","code_information":[{"code":"16777","type":"CDM"},{"code":"300","type":"RC"},{"code":"81500","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":870.7,"discounted_cash":435.35,"setting":"both","billing_class":"facility"}]},{"description":"SEMEN ANAL SPERM DET","code_information":[{"code":"16780","type":"CDM"},{"code":"300","type":"RC"},{"code":"89321","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.85,"discounted_cash":27.43,"setting":"both","billing_class":"facility"}]},{"description":"VECTRA","code_information":[{"code":"16781","type":"CDM"},{"code":"300","type":"RC"},{"code":"81490","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2554.65,"discounted_cash":1277.33,"setting":"both","billing_class":"facility"}]},{"description":"DRUG ASSAY VORICONAZ","code_information":[{"code":"16782","type":"CDM"},{"code":"301","type":"RC"},{"code":"80285","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":115.25,"discounted_cash":57.63,"setting":"both","billing_class":"facility"}]},{"description":"SALMONELLA ANTIBODY","code_information":[{"code":"16783","type":"CDM"},{"code":"300","type":"RC"},{"code":"86768","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.1,"discounted_cash":30.05,"setting":"both","billing_class":"facility"}]},{"description":"ASSAY OF SOMATOSTATI","code_information":[{"code":"16784","type":"CDM"},{"code":"301","type":"RC"},{"code":"84307","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.2,"discounted_cash":41.6,"setting":"both","billing_class":"facility"}]},{"description":"ESTRONE","code_information":[{"code":"16792","type":"CDM"},{"code":"300","type":"RC"},{"code":"82679","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.7,"discounted_cash":36.35,"setting":"both","billing_class":"facility"}]},{"description":"GLUCAGON","code_information":[{"code":"16793","type":"CDM"},{"code":"301","type":"RC"},{"code":"82943","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.4,"discounted_cash":32.7,"setting":"both","billing_class":"facility"}]},{"description":"METHADONE","code_information":[{"code":"16794","type":"CDM"},{"code":"300","type":"RC"},{"code":"80358","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":35.15,"setting":"both","billing_class":"facility"}]},{"description":"CLONAZEPAM QT","code_information":[{"code":"16795","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":212.1,"discounted_cash":106.05,"setting":"both","billing_class":"facility"}]},{"description":"ALPRAZOLM QUANT URNE","code_information":[{"code":"16796","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":427.75,"discounted_cash":213.88,"setting":"both","billing_class":"facility"}]},{"description":"PARVOVIRUS B19 IGG&M","code_information":[{"code":"16801","type":"CDM"},{"code":"302","type":"RC"},{"code":"86747","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":71.9,"discounted_cash":35.95,"setting":"both","billing_class":"facility"}]},{"description":"RBC INC W/CHEM/DRUG","code_information":[{"code":"16806","type":"CDM"},{"code":"302","type":"RC"},{"code":"86970","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.25,"discounted_cash":109.63,"setting":"both","billing_class":"facility"}]},{"description":"ABO BLOOD TYPE","code_information":[{"code":"16812","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":145.4,"discounted_cash":72.7,"setting":"both","billing_class":"facility"}]},{"description":"RH TYPE","code_information":[{"code":"16815","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.85,"discounted_cash":42.42,"setting":"both","billing_class":"facility"}]},{"description":"PNEUMOCYSTIS DFA","code_information":[{"code":"16816","type":"CDM"},{"code":"306","type":"RC"},{"code":"87281","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":297.3,"discounted_cash":148.65,"setting":"both","billing_class":"facility"}]},{"description":"AG SCREEN EA UNIT","code_information":[{"code":"16818","type":"CDM"},{"code":"300","type":"RC"},{"code":"86902","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.7,"discounted_cash":124.85,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD TYP RBC ANTIGN","code_information":[{"code":"16820","type":"CDM"},{"code":"302","type":"RC"},{"code":"86905","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":310.83,"discounted_cash":155.41,"setting":"both","billing_class":"facility"}]},{"description":"DIRECT COOMBS","code_information":[{"code":"16822","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":145.4,"discounted_cash":72.7,"setting":"both","billing_class":"facility"}]},{"description":"AB ID RBC EA","code_information":[{"code":"16825","type":"CDM"},{"code":"300","type":"RC"},{"code":"86870","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":506.6,"discounted_cash":253.3,"setting":"both","billing_class":"facility"}]},{"description":"AB SCREEN","code_information":[{"code":"16826","type":"CDM"},{"code":"300","type":"RC"},{"code":"86850","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":81.2,"discounted_cash":40.6,"setting":"both","billing_class":"facility"}]},{"description":"XM EA UNIT IS","code_information":[{"code":"16829","type":"CDM"},{"code":"300","type":"RC"},{"code":"86920","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.7,"discounted_cash":124.85,"setting":"both","billing_class":"facility"}]},{"description":"XM EA UNIT AHG","code_information":[{"code":"16831","type":"CDM"},{"code":"300","type":"RC"},{"code":"86922","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.7,"discounted_cash":124.85,"setting":"both","billing_class":"facility"}]},{"description":"AUTOABSORPTION","code_information":[{"code":"16839","type":"CDM"},{"code":"302","type":"RC"},{"code":"86978","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.25,"discounted_cash":29.13,"setting":"both","billing_class":"facility"}]},{"description":"CRYOPRECIP THAW/UNIT","code_information":[{"code":"16840","type":"CDM"},{"code":"300","type":"RC"},{"code":"86999","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.8,"discounted_cash":39.4,"setting":"both","billing_class":"facility"}]},{"description":"AB JO-1","code_information":[{"code":"16841","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":98.4,"discounted_cash":49.2,"setting":"both","billing_class":"facility"}]},{"description":"AB MUMPS IGG","code_information":[{"code":"16845","type":"CDM"},{"code":"300","type":"RC"},{"code":"86735","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":71.55,"discounted_cash":35.77,"setting":"both","billing_class":"facility"}]},{"description":"IGF P-3","code_information":[{"code":"16847","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":35.15,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM STOOL","code_information":[{"code":"16848","type":"CDM"},{"code":"301","type":"RC"},{"code":"84302","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.9,"discounted_cash":16.95,"setting":"both","billing_class":"facility"}]},{"description":"POTASSIUM STOOL","code_information":[{"code":"16849","type":"CDM"},{"code":"301","type":"RC"},{"code":"82190","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.1,"discounted_cash":37.55,"setting":"both","billing_class":"facility"}]},{"description":"AB MUMPS IGM","code_information":[{"code":"16851","type":"CDM"},{"code":"300","type":"RC"},{"code":"86735","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":71.55,"discounted_cash":35.77,"setting":"both","billing_class":"facility"}]},{"description":"AB ACTINOMYCES","code_information":[{"code":"16862","type":"CDM"},{"code":"302","type":"RC"},{"code":"86602","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.45,"discounted_cash":24.23,"setting":"both","billing_class":"facility"}]},{"description":"AB HISTONE","code_information":[{"code":"16863","type":"CDM"},{"code":"301","type":"RC"},{"code":"83520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":79.7,"discounted_cash":39.85,"setting":"both","billing_class":"facility"}]},{"description":"HEP B DNA, QL PCR","code_information":[{"code":"16880","type":"CDM"},{"code":"306","type":"RC"},{"code":"87516","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":369.35,"discounted_cash":184.68,"setting":"both","billing_class":"facility"}]},{"description":"CULT HSV IMMFLUOR","code_information":[{"code":"16898","type":"CDM"},{"code":"306","type":"RC"},{"code":"87254","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":93.7,"discounted_cash":46.85,"setting":"both","billing_class":"facility"}]},{"description":"PAPILLOMA HUMAN PCR","code_information":[{"code":"16903","type":"CDM"},{"code":"300","type":"RC"},{"code":"87624","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.65,"discounted_cash":63.33,"setting":"both","billing_class":"facility"}]},{"description":"CULT STOOL ADDL PATH","code_information":[{"code":"16905","type":"CDM"},{"code":"300","type":"RC"},{"code":"87046","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.7,"discounted_cash":31.35,"setting":"both","billing_class":"facility"}]},{"description":"AB WEST NILE VIRUS","code_information":[{"code":"16908","type":"CDM"},{"code":"300","type":"RC"},{"code":"86790","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":122.65,"discounted_cash":61.33,"setting":"both","billing_class":"facility"}]},{"description":"ORGANIC ACID SGL QLT","code_information":[{"code":"16910","type":"CDM"},{"code":"300","type":"RC"},{"code":"83921","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.05,"discounted_cash":63.02,"setting":"both","billing_class":"facility"}]},{"description":"BLD BNK PHY SVC I/R","code_information":[{"code":"16919","type":"CDM"},{"code":"310","type":"RC"},{"code":"86077","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":697.25,"discounted_cash":348.63,"setting":"both","billing_class":"facility"}]},{"description":"ROCKY MTN SPOT FVR","code_information":[{"code":"16924","type":"CDM"},{"code":"302","type":"RC"},{"code":"86757","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":92.65,"discounted_cash":46.33,"setting":"both","billing_class":"facility"}]},{"description":"AB WEST NILE IGG","code_information":[{"code":"16926","type":"CDM"},{"code":"300","type":"RC"},{"code":"86789","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":122.65,"discounted_cash":61.33,"setting":"both","billing_class":"facility"}]},{"description":"AB WEST NILE IGM","code_information":[{"code":"16927","type":"CDM"},{"code":"300","type":"RC"},{"code":"86788","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":122.65,"discounted_cash":61.33,"setting":"both","billing_class":"facility"}]},{"description":"TISSUE IN SITU","code_information":[{"code":"16932","type":"CDM"},{"code":"300","type":"RC"},{"code":"88365","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":160.0,"setting":"both","billing_class":"facility"}]},{"description":"IN SITU HYBRID EA AD","code_information":[{"code":"16933","type":"CDM"},{"code":"300","type":"RC"},{"code":"88364","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":160.0,"setting":"both","billing_class":"facility"}]},{"description":"ALCOHOL MET W/CONFIR","code_information":[{"code":"16938","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.2,"discounted_cash":112.1,"setting":"both","billing_class":"facility"}]},{"description":"ANTI IGA AB (IGG)","code_information":[{"code":"16941","type":"CDM"},{"code":"301","type":"RC"},{"code":"83520","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":376.95,"discounted_cash":188.47,"setting":"both","billing_class":"facility"}]},{"description":"CRYOFIBRINOGEN","code_information":[{"code":"16945","type":"CDM"},{"code":"300","type":"RC"},{"code":"82585","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.55,"discounted_cash":27.27,"setting":"both","billing_class":"facility"}]},{"description":"BENZO WITH MEDMATCH","code_information":[{"code":"16946","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":212.1,"discounted_cash":106.05,"setting":"both","billing_class":"facility"}]},{"description":"THYROX BINDING GLOB","code_information":[{"code":"16947","type":"CDM"},{"code":"301","type":"RC"},{"code":"84442","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.2,"discounted_cash":20.6,"setting":"both","billing_class":"facility"}]},{"description":"UGT1A1 GENE","code_information":[{"code":"16948","type":"CDM"},{"code":"301","type":"RC"},{"code":"81350","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":729.25,"discounted_cash":364.63,"setting":"both","billing_class":"facility"}]},{"description":"OMEGA 3&6 FATTY ACID","code_information":[{"code":"16949","type":"CDM"},{"code":"301","type":"RC"},{"code":"82542","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":105.4,"discounted_cash":52.7,"setting":"both","billing_class":"facility"}]},{"description":"PROGESTERONE FREE","code_information":[{"code":"16950","type":"CDM"},{"code":"301","type":"RC"},{"code":"83519","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":442.35,"discounted_cash":221.18,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL URINE PM","code_information":[{"code":"16958","type":"CDM"},{"code":"300","type":"RC"},{"code":"80354","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.7,"discounted_cash":36.35,"setting":"both","billing_class":"facility"}]},{"description":"CHOLESTANOL","code_information":[{"code":"16959","type":"CDM"},{"code":"301","type":"RC"},{"code":"82542","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.55,"discounted_cash":241.78,"setting":"both","billing_class":"facility"}]},{"description":"NPN MUTATION","code_information":[{"code":"16960","type":"CDM"},{"code":"310","type":"RC"},{"code":"81310","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":833.2,"discounted_cash":416.6,"setting":"both","billing_class":"facility"}]},{"description":"PHENOLPHTHAL, FECES","code_information":[{"code":"16961","type":"CDM"},{"code":"301","type":"RC"},{"code":"84311","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.2,"discounted_cash":52.1,"setting":"both","billing_class":"facility"}]},{"description":"LIVER KIDNEY MICR AB","code_information":[{"code":"16962","type":"CDM"},{"code":"302","type":"RC"},{"code":"86376","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":85.3,"discounted_cash":42.65,"setting":"both","billing_class":"facility"}]},{"description":"ITRACONAZOLE LEVEL","code_information":[{"code":"16963","type":"CDM"},{"code":"301","type":"RC"},{"code":"80299","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.3,"discounted_cash":75.15,"setting":"both","billing_class":"facility"}]},{"description":"IA INFECTIOUS AGENT","code_information":[{"code":"16964","type":"CDM"},{"code":"302","type":"RC"},{"code":"86317","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.05,"discounted_cash":24.02,"setting":"both","billing_class":"facility"}]},{"description":"ALLERGEN IGG EACH","code_information":[{"code":"16965","type":"CDM"},{"code":"302","type":"RC"},{"code":"86001","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.65,"discounted_cash":41.33,"setting":"both","billing_class":"facility"}]},{"description":"CHYMOTRYPSIN, STOOL","code_information":[{"code":"16966","type":"CDM"},{"code":"301","type":"RC"},{"code":"84311","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.85,"discounted_cash":17.43,"setting":"both","billing_class":"facility"}]},{"description":"CYP2C19 GENE COM VAR","code_information":[{"code":"16967","type":"CDM"},{"code":"310","type":"RC"},{"code":"81225","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1059.45,"discounted_cash":529.73,"setting":"both","billing_class":"facility"}]},{"description":"CYP2D6 GENE ANALYSIS","code_information":[{"code":"16968","type":"CDM"},{"code":"310","type":"RC"},{"code":"81226","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1639.5,"discounted_cash":819.75,"setting":"both","billing_class":"facility"}]},{"description":"CYP2C9 GENE ANALYSIS","code_information":[{"code":"16969","type":"CDM"},{"code":"310","type":"RC"},{"code":"81227","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":635.6,"discounted_cash":317.8,"setting":"both","billing_class":"facility"}]},{"description":"CYP3A4 GENE ANALYSIS","code_information":[{"code":"16970","type":"CDM"},{"code":"310","type":"RC"},{"code":"81230","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":635.6,"discounted_cash":317.8,"setting":"both","billing_class":"facility"}]},{"description":"CYP3A5 GENE ANALYSIS","code_information":[{"code":"16971","type":"CDM"},{"code":"310","type":"RC"},{"code":"81231","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":635.6,"discounted_cash":317.8,"setting":"both","billing_class":"facility"}]},{"description":"DYPD GENE ANALYSIS","code_information":[{"code":"16972","type":"CDM"},{"code":"310","type":"RC"},{"code":"81232","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":635.6,"discounted_cash":317.8,"setting":"both","billing_class":"facility"}]},{"description":"G6PD GENE ANALYSIS C","code_information":[{"code":"16973","type":"CDM"},{"code":"310","type":"RC"},{"code":"81247","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":635.6,"discounted_cash":317.8,"setting":"both","billing_class":"facility"}]},{"description":"IFNL3 GENE ANALYSIS","code_information":[{"code":"16974","type":"CDM"},{"code":"310","type":"RC"},{"code":"81283","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.75,"discounted_cash":133.38,"setting":"both","billing_class":"facility"}]},{"description":"NUDT15 GENE ANALYSIS","code_information":[{"code":"16975","type":"CDM"},{"code":"310","type":"RC"},{"code":"81306","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1059.45,"discounted_cash":529.73,"setting":"both","billing_class":"facility"}]},{"description":"SLCO1B1 GENE ANALYSI","code_information":[{"code":"16976","type":"CDM"},{"code":"310","type":"RC"},{"code":"81328","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":635.6,"discounted_cash":317.8,"setting":"both","billing_class":"facility"}]},{"description":"UGT1A1 GENE ANALYSIS","code_information":[{"code":"16977","type":"CDM"},{"code":"310","type":"RC"},{"code":"81350","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":850.8,"discounted_cash":425.4,"setting":"both","billing_class":"facility"}]},{"description":"VKORC1 GENE ANALYSIS","code_information":[{"code":"16978","type":"CDM"},{"code":"310","type":"RC"},{"code":"81355","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":320.7,"discounted_cash":160.35,"setting":"both","billing_class":"facility"}]},{"description":"HLA I TYPING 1ALLELE","code_information":[{"code":"16979","type":"CDM"},{"code":"310","type":"RC"},{"code":"81381","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":617.75,"discounted_cash":308.88,"setting":"both","billing_class":"facility"}]},{"description":"MOLECULAR PTH LEVEL1","code_information":[{"code":"16980","type":"CDM"},{"code":"310","type":"RC"},{"code":"81400","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":232.5,"discounted_cash":116.25,"setting":"both","billing_class":"facility"}]},{"description":"TPMT GENE ANALAYSIS","code_information":[{"code":"16981","type":"CDM"},{"code":"310","type":"RC"},{"code":"81335","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":635.6,"discounted_cash":317.8,"setting":"both","billing_class":"facility"}]},{"description":"HUMAN EPIDIDYMIS PTN","code_information":[{"code":"16982","type":"CDM"},{"code":"302","type":"RC"},{"code":"86305","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.1,"discounted_cash":42.05,"setting":"both","billing_class":"facility"}]},{"description":"MULTIPLEX PROBE STN","code_information":[{"code":"16983","type":"CDM"},{"code":"310","type":"RC"},{"code":"88377","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":470.1,"discounted_cash":235.05,"setting":"both","billing_class":"facility"}]},{"description":"SMN1 GENE DOS/DLTIN","code_information":[{"code":"16984","type":"CDM"},{"code":"310","type":"RC"},{"code":"81329","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":498.1,"discounted_cash":249.05,"setting":"both","billing_class":"facility"}]},{"description":"COAGULATION TIME ACT","code_information":[{"code":"16985","type":"CDM"},{"code":"305","type":"RC"},{"code":"85347","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.2,"discounted_cash":8.6,"setting":"both","billing_class":"facility"}]},{"description":"QUANTITATIVE DRUG AS","code_information":[{"code":"16986","type":"CDM"},{"code":"301","type":"RC"},{"code":"80299","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.85,"discounted_cash":42.42,"setting":"both","billing_class":"facility"}]},{"description":"SULFATE URINE","code_information":[{"code":"16987","type":"CDM"},{"code":"301","type":"RC"},{"code":"84392","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":13.32,"setting":"both","billing_class":"facility"}]},{"description":"B CELLS TOTAL COUNT","code_information":[{"code":"16988","type":"CDM"},{"code":"302","type":"RC"},{"code":"86355","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":168.15,"discounted_cash":84.08,"setting":"both","billing_class":"facility"}]},{"description":"GENOTYPE DNA HIV REV","code_information":[{"code":"16989","type":"CDM"},{"code":"306","type":"RC"},{"code":"87901","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":953.55,"discounted_cash":476.77,"setting":"both","billing_class":"facility"}]},{"description":"ASSAY OF HEMOSIDERIN","code_information":[{"code":"16990","type":"CDM"},{"code":"301","type":"RC"},{"code":"83070","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.45,"discounted_cash":12.72,"setting":"both","billing_class":"facility"}]},{"description":"FETAL CHRMOML ANEUPL","code_information":[{"code":"16991","type":"CDM"},{"code":"310","type":"RC"},{"code":"81420","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2300.15,"discounted_cash":1150.08,"setting":"both","billing_class":"facility"}]},{"description":"PHENOTYPE INFECT AGT","code_information":[{"code":"16992","type":"CDM"},{"code":"306","type":"RC"},{"code":"87900","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":526.55,"discounted_cash":263.27,"setting":"both","billing_class":"facility"}]},{"description":"IADNA-DNA/RNA PROBE","code_information":[{"code":"16993","type":"CDM"},{"code":"306","type":"RC"},{"code":"87506","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":876.6,"discounted_cash":438.3,"setting":"both","billing_class":"facility"}]},{"description":"PHOSPHOLIPID PLTLT N","code_information":[{"code":"16994","type":"CDM"},{"code":"305","type":"RC"},{"code":"85597","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":90.85,"discounted_cash":45.42,"setting":"both","billing_class":"facility"}]},{"description":"HEXAGNAL PHOSPH PLTL","code_information":[{"code":"16995","type":"CDM"},{"code":"305","type":"RC"},{"code":"85598","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":90.85,"discounted_cash":45.42,"setting":"both","billing_class":"facility"}]},{"description":"PROTHROMBIN TEST","code_information":[{"code":"16996","type":"CDM"},{"code":"305","type":"RC"},{"code":"85611","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":12.13,"setting":"both","billing_class":"facility"}]},{"description":"DRUG ASSY EVEROLIMUS","code_information":[{"code":"16997","type":"CDM"},{"code":"301","type":"RC"},{"code":"80169","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.35,"discounted_cash":34.67,"setting":"both","billing_class":"facility"}]},{"description":"ALPHA 2-ANTIPLASMIN","code_information":[{"code":"16999","type":"CDM"},{"code":"305","type":"RC"},{"code":"85410","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":21.63,"setting":"both","billing_class":"facility"}]},{"description":"APP MLTL COMP LWR LG","code_information":[{"code":"17","type":"CDM"},{"code":"761","type":"RC"},{"code":"29581","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.05,"discounted_cash":227.53,"setting":"both","billing_class":"facility"}]},{"description":"WEDGE EXCISION","code_information":[{"code":"1700","type":"CDM"},{"code":"510","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":424.2,"discounted_cash":212.1,"setting":"both","billing_class":"facility"}]},{"description":"RH PHENOTYPING","code_information":[{"code":"17000","type":"CDM"},{"code":"300","type":"RC"},{"code":"86906","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":136.35,"discounted_cash":68.17,"setting":"both","billing_class":"facility"}]},{"description":"PDGFRA MUTATION ALYS","code_information":[{"code":"17001","type":"CDM"},{"code":"310","type":"RC"},{"code":"81314","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1208.25,"discounted_cash":604.13,"setting":"both","billing_class":"facility"}]},{"description":"ADALIMUMAB DRUG ASSY","code_information":[{"code":"17002","type":"CDM"},{"code":"300","type":"RC"},{"code":"80145","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":171.85,"discounted_cash":85.92,"setting":"both","billing_class":"facility"}]},{"description":"STREP B DNA AMP PROB","code_information":[{"code":"17003","type":"CDM"},{"code":"306","type":"RC"},{"code":"87653","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":152.7,"discounted_cash":76.35,"setting":"both","billing_class":"facility"}]},{"description":"RSV DNA/RNA AMP PROB","code_information":[{"code":"17004","type":"CDM"},{"code":"306","type":"RC"},{"code":"87634","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":290.25,"discounted_cash":145.13,"setting":"both","billing_class":"facility"}]},{"description":"LACOSAMIDE DRUG ASSA","code_information":[{"code":"17005","type":"CDM"},{"code":"300","type":"RC"},{"code":"80235","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.9,"discounted_cash":60.45,"setting":"both","billing_class":"facility"}]},{"description":"DETECT AGNT MULT DNA","code_information":[{"code":"17006","type":"CDM"},{"code":"306","type":"RC"},{"code":"87801","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":290.25,"discounted_cash":145.13,"setting":"both","billing_class":"facility"}]},{"description":"DRUG SCRN QUAN LEVET","code_information":[{"code":"17007","type":"CDM"},{"code":"301","type":"RC"},{"code":"80177","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.3,"discounted_cash":31.65,"setting":"both","billing_class":"facility"}]},{"description":"M GENITALIUM AMP PRB","code_information":[{"code":"17008","type":"CDM"},{"code":"306","type":"RC"},{"code":"87563","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":156.35,"discounted_cash":78.17,"setting":"both","billing_class":"facility"}]},{"description":"IGK REARRANGEABN CLO","code_information":[{"code":"17009","type":"CDM"},{"code":"310","type":"RC"},{"code":"81264","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":659.35,"discounted_cash":329.68,"setting":"both","billing_class":"facility"}]},{"description":"CANALITH REPOSITION","code_information":[{"code":"1701","type":"CDM"},{"code":"510","type":"RC"},{"code":"95992","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.5,"discounted_cash":55.75,"setting":"both","billing_class":"facility"}]},{"description":"METHYLENEDIOXYAMPHET","code_information":[{"code":"17011","type":"CDM"},{"code":"309","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.4,"discounted_cash":212.7,"setting":"both","billing_class":"facility"}]},{"description":"DRUG ASY VEDOLIZUMAB","code_information":[{"code":"17012","type":"CDM"},{"code":"301","type":"RC"},{"code":"80280","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":171.85,"discounted_cash":85.92,"setting":"both","billing_class":"facility"}]},{"description":"SHIGA-LIKE TOXIN AG","code_information":[{"code":"17013","type":"CDM"},{"code":"306","type":"RC"},{"code":"87427","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.2,"discounted_cash":28.6,"setting":"both","billing_class":"facility"}]},{"description":"CYTOGENETICS 10-30","code_information":[{"code":"17014","type":"CDM"},{"code":"311","type":"RC"},{"code":"88273","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":155.15,"discounted_cash":77.58,"setting":"both","billing_class":"facility"}]},{"description":"COVID RAPID TEST","code_information":[{"code":"17015","type":"CDM"},{"code":"302","type":"RC"},{"code":"87426","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":186.95,"discounted_cash":93.47,"setting":"both","billing_class":"facility"}]},{"description":"BCR/ABL1 GN MN ZB3RV","code_information":[{"code":"17016","type":"CDM"},{"code":"310","type":"RC"},{"code":"81207","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility"}]},{"description":"SARSCOV2 INF A B RSV","code_information":[{"code":"17017","type":"CDM"},{"code":"306","type":"RC"},{"code":"87637","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":545.4,"discounted_cash":272.7,"setting":"both","billing_class":"facility"}]},{"description":"TESTOSTERONE BIOAVAI","code_information":[{"code":"17018","type":"CDM"},{"code":"301","type":"RC"},{"code":"84410","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":101.0,"setting":"both","billing_class":"facility"}]},{"description":"GABAPENTIN DRG SCRN","code_information":[{"code":"17019","type":"CDM"},{"code":"301","type":"RC"},{"code":"80171","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.4,"discounted_cash":48.2,"setting":"both","billing_class":"facility"}]},{"description":"WKEND/HOL W/BASIC SV","code_information":[{"code":"1702","type":"CDM"},{"code":"510","type":"RC"},{"code":"99050","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":43.6,"discounted_cash":21.8,"setting":"both","billing_class":"facility"}]},{"description":"ASY CARBAMAZEPIN 10","code_information":[{"code":"17020","type":"CDM"},{"code":"301","type":"RC"},{"code":"80161","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.9,"discounted_cash":44.45,"setting":"both","billing_class":"facility"}]},{"description":"ASSAY OF TRANSCORTIN","code_information":[{"code":"17021","type":"CDM"},{"code":"301","type":"RC"},{"code":"84449","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.1,"discounted_cash":41.05,"setting":"both","billing_class":"facility"}]},{"description":"CHROMOGENIC SUBSTRAT","code_information":[{"code":"17022","type":"CDM"},{"code":"305","type":"RC"},{"code":"85130","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.35,"discounted_cash":112.17,"setting":"both","billing_class":"facility"}]},{"description":"FLUORESCENT ANTIBODY","code_information":[{"code":"17023","type":"CDM"},{"code":"302","type":"RC"},{"code":"86256","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.6,"discounted_cash":28.8,"setting":"both","billing_class":"facility"}]},{"description":"HLA I TYPING 1 LOCUS","code_information":[{"code":"17025","type":"CDM"},{"code":"310","type":"RC"},{"code":"81373","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":487.45,"discounted_cash":243.72,"setting":"both","billing_class":"facility"}]},{"description":"ANCA SCREEN EA ANTTI","code_information":[{"code":"17026","type":"CDM"},{"code":"302","type":"RC"},{"code":"86036","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":28.88,"setting":"both","billing_class":"facility"}]},{"description":"HLA II TYPE 1 AG EQU","code_information":[{"code":"17027","type":"CDM"},{"code":"310","type":"RC"},{"code":"81377","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":374.3,"discounted_cash":187.15,"setting":"both","billing_class":"facility"}]},{"description":"HBA1/HBA2 GENE","code_information":[{"code":"17028","type":"CDM"},{"code":"300","type":"RC"},{"code":"81257","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":372.5,"discounted_cash":186.25,"setting":"both","billing_class":"facility"}]},{"description":"DRUG ASSY INFLIXIMAB","code_information":[{"code":"17029","type":"CDM"},{"code":"301","type":"RC"},{"code":"80230","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":172.2,"discounted_cash":86.1,"setting":"both","billing_class":"facility"}]},{"description":"CRYPTOCOCCUS ANTBODY","code_information":[{"code":"17030","type":"CDM"},{"code":"302","type":"RC"},{"code":"86641","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.05,"discounted_cash":34.52,"setting":"both","billing_class":"facility"}]},{"description":"MITOCHONDRIAL ANTBDY","code_information":[{"code":"17031","type":"CDM"},{"code":"302","type":"RC"},{"code":"86381","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.2,"discounted_cash":54.6,"setting":"both","billing_class":"facility"}]},{"description":"HTT GENE DETC ABNOR","code_information":[{"code":"17032","type":"CDM"},{"code":"300","type":"RC"},{"code":"81271","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":524.2,"discounted_cash":262.1,"setting":"both","billing_class":"facility"}]},{"description":"ANCA TITER EA ANTBDY","code_information":[{"code":"17033","type":"CDM"},{"code":"302","type":"RC"},{"code":"86037","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":28.88,"setting":"both","billing_class":"facility"}]},{"description":"HBB GENE COM VARIANT","code_information":[{"code":"17034","type":"CDM"},{"code":"300","type":"RC"},{"code":"81361","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":668.85,"discounted_cash":334.43,"setting":"both","billing_class":"facility"}]},{"description":"HEXA GENE","code_information":[{"code":"17035","type":"CDM"},{"code":"300","type":"RC"},{"code":"81255","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":213.15,"discounted_cash":106.58,"setting":"both","billing_class":"facility"}]},{"description":"ASPA GENE","code_information":[{"code":"17036","type":"CDM"},{"code":"300","type":"RC"},{"code":"81200","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":211.05,"discounted_cash":105.53,"setting":"both","billing_class":"facility"}]},{"description":"DRUG COLLECTION","code_information":[{"code":"17037","type":"CDM"},{"code":"300","type":"RC"},{"code":"99001","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.45,"discounted_cash":24.23,"setting":"both","billing_class":"facility"}]},{"description":"DRUG COLL SPECIAL","code_information":[{"code":"17038","type":"CDM"},{"code":"300","type":"RC"},{"code":"99001","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.55,"discounted_cash":27.27,"setting":"both","billing_class":"facility"}]},{"description":"VONHIPPEL MOPATH 5","code_information":[{"code":"17040","type":"CDM"},{"code":"300","type":"RC"},{"code":"81404","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1221.25,"discounted_cash":610.63,"setting":"both","billing_class":"facility"}]},{"description":"O2 DISSOCIATION P50","code_information":[{"code":"17041","type":"CDM"},{"code":"300","type":"RC"},{"code":"82820","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":769.65,"discounted_cash":384.82,"setting":"both","billing_class":"facility"}]},{"description":"TCA PANEL 3","code_information":[{"code":"17043","type":"CDM"},{"code":"300","type":"RC"},{"code":"80336","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility"}]},{"description":"LEFLUNOMIDE","code_information":[{"code":"17044","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":313.9,"discounted_cash":156.95,"setting":"both","billing_class":"facility"}]},{"description":"SELENIUM LVL","code_information":[{"code":"17048","type":"CDM"},{"code":"300","type":"RC"},{"code":"84255","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.85,"discounted_cash":42.42,"setting":"both","billing_class":"facility"}]},{"description":"CYANCOB BINDING CAP","code_information":[{"code":"17049","type":"CDM"},{"code":"300","type":"RC"},{"code":"82608","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.7,"discounted_cash":36.35,"setting":"both","billing_class":"facility"}]},{"description":"GAD IMMUNO QT B","code_information":[{"code":"17057","type":"CDM"},{"code":"300","type":"RC"},{"code":"86341","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.65,"discounted_cash":25.32,"setting":"both","billing_class":"facility"}]},{"description":"HEPATITIC C RNA QUAL","code_information":[{"code":"17096","type":"CDM"},{"code":"306","type":"RC"},{"code":"87521","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":398.65,"discounted_cash":199.32,"setting":"both","billing_class":"facility"}]},{"description":"VITAMIN NOS","code_information":[{"code":"17098","type":"CDM"},{"code":"301","type":"RC"},{"code":"84591","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":189.05,"discounted_cash":94.53,"setting":"both","billing_class":"facility"}]},{"description":"CFVANTAGE EXPANDED","code_information":[{"code":"17099","type":"CDM"},{"code":"310","type":"RC"},{"code":"81220","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1127.95,"discounted_cash":563.98,"setting":"both","billing_class":"facility"}]},{"description":"FLUNITR & METABS QNT","code_information":[{"code":"17101","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":378.15,"discounted_cash":189.07,"setting":"both","billing_class":"facility"}]},{"description":"AML PROGNOSTIC PANEL","code_information":[{"code":"17102","type":"CDM"},{"code":"310","type":"RC"},{"code":"81245","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2191.8,"discounted_cash":1095.9,"setting":"both","billing_class":"facility"}]},{"description":"FISH, MDS/MYELOD PNL","code_information":[{"code":"17103","type":"CDM"},{"code":"310","type":"RC"},{"code":"88275","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1012.15,"discounted_cash":506.07,"setting":"both","billing_class":"facility"}]},{"description":"PROCALCITONIN","code_information":[{"code":"17122","type":"CDM"},{"code":"301","type":"RC"},{"code":"84145","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":276.35,"discounted_cash":138.18,"setting":"both","billing_class":"facility"}]},{"description":"CIRCULATING TUMOR CE","code_information":[{"code":"17123","type":"CDM"},{"code":"302","type":"RC"},{"code":"86152","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1235.6,"discounted_cash":617.8,"setting":"both","billing_class":"facility"}]},{"description":"IODINE, RANDOM URINE","code_information":[{"code":"17124","type":"CDM"},{"code":"301","type":"RC"},{"code":"83789","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":155.15,"discounted_cash":77.58,"setting":"both","billing_class":"facility"}]},{"description":"PLATELET COUNT, CITR","code_information":[{"code":"17125","type":"CDM"},{"code":"305","type":"RC"},{"code":"85049","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.6,"discounted_cash":15.8,"setting":"both","billing_class":"facility"}]},{"description":"INFT AGT DETECT DNA","code_information":[{"code":"17126","type":"CDM"},{"code":"306","type":"RC"},{"code":"87505","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":703.95,"discounted_cash":351.98,"setting":"both","billing_class":"facility"}]},{"description":"LACTOFERRIN FECAL QN","code_information":[{"code":"17127","type":"CDM"},{"code":"301","type":"RC"},{"code":"83631","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":114.25,"discounted_cash":57.13,"setting":"both","billing_class":"facility"}]},{"description":"TRAMADOL QN UR","code_information":[{"code":"17128","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":212.1,"discounted_cash":106.05,"setting":"both","billing_class":"facility"}]},{"description":"HPV 16 18/45 GENOTYP","code_information":[{"code":"17129","type":"CDM"},{"code":"306","type":"RC"},{"code":"87625","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.65,"discounted_cash":112.33,"setting":"both","billing_class":"facility"}]},{"description":"DRUG PANEL 10 URINE","code_information":[{"code":"17130","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":128.75,"setting":"both","billing_class":"facility"}]},{"description":"BUPRENORPHINE QNT UR","code_information":[{"code":"17131","type":"CDM"},{"code":"301","type":"RC"},{"code":"G0480","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":427.8,"discounted_cash":213.9,"setting":"both","billing_class":"facility"}]},{"description":"TPMT GENOTYPE","code_information":[{"code":"17132","type":"CDM"},{"code":"310","type":"RC"},{"code":"81401","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":239.95,"discounted_cash":119.97,"setting":"both","billing_class":"facility"}]},{"description":"THIOPURINE METAB","code_information":[{"code":"17133","type":"CDM"},{"code":"301","type":"RC"},{"code":"80299","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":97.45,"discounted_cash":48.73,"setting":"both","billing_class":"facility"}]},{"description":"STRESS TEST TRACING","code_information":[{"code":"17930","type":"CDM"},{"code":"482","type":"RC"},{"code":"93017","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1279.86,"discounted_cash":639.93,"setting":"both","billing_class":"facility"}]},{"description":"HOLTER 48HR RECORD","code_information":[{"code":"17931","type":"CDM"},{"code":"731","type":"RC"},{"code":"93225","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":716.92,"discounted_cash":358.46,"setting":"both","billing_class":"facility"}]},{"description":"HOLTER 48HR SCAN/RPT","code_information":[{"code":"17932","type":"CDM"},{"code":"731","type":"RC"},{"code":"93226","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.8,"discounted_cash":287.4,"setting":"both","billing_class":"facility"}]},{"description":"ECHO D&M LTD","code_information":[{"code":"17933","type":"CDM"},{"code":"483","type":"RC"},{"code":"93308","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":818.18,"discounted_cash":409.09,"setting":"both","billing_class":"facility"}]},{"description":"TRANSESOPH ECHO","code_information":[{"code":"17934","type":"CDM"},{"code":"483","type":"RC"},{"code":"93312","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2389.92,"discounted_cash":1194.96,"setting":"both","billing_class":"facility"}]},{"description":"ECHO COLOR DOP","code_information":[{"code":"17935","type":"CDM"},{"code":"483","type":"RC"},{"code":"93325","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":879.68,"discounted_cash":439.84,"setting":"both","billing_class":"facility"}]},{"description":"STRESS ECHO","code_information":[{"code":"17936","type":"CDM"},{"code":"483","type":"RC"},{"code":"93350","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1986.81,"discounted_cash":993.4,"setting":"both","billing_class":"facility"}]},{"description":"ECHO DOP COMP","code_information":[{"code":"17937","type":"CDM"},{"code":"483","type":"RC"},{"code":"93320","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1026.35,"discounted_cash":513.17,"setting":"both","billing_class":"facility"}]},{"description":"CARDIO STRESS TEST","code_information":[{"code":"17938","type":"CDM"},{"code":"482","type":"RC"},{"code":"93015","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1266.75,"discounted_cash":633.38,"setting":"both","billing_class":"facility"}]},{"description":"ECHO TTHRC CONGNTAL","code_information":[{"code":"17939","type":"CDM"},{"code":"483","type":"RC"},{"code":"93303","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1582.08,"discounted_cash":791.04,"setting":"both","billing_class":"facility"}]},{"description":"TTE W/DOPPLER COMP","code_information":[{"code":"17940","type":"CDM"},{"code":"480","type":"RC"},{"code":"93306","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":2582.3,"discounted_cash":1291.15,"setting":"both","billing_class":"facility"}]},{"description":"INJ IV BUBBLE STUDY","code_information":[{"code":"17941","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":119.2,"discounted_cash":59.6,"setting":"both","billing_class":"facility"}]},{"description":"STRESS TST PHY SUPRV","code_information":[{"code":"17942","type":"CDM"},{"code":"985","type":"RC"},{"code":"93016","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":51.31,"discounted_cash":25.66,"setting":"both","billing_class":"facility"}]},{"description":"STRESS TST INT/RPT","code_information":[{"code":"17943","type":"CDM"},{"code":"985","type":"RC"},{"code":"93018","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.16,"discounted_cash":17.58,"setting":"both","billing_class":"facility"}]},{"description":"48HR HLTER INT/RPT","code_information":[{"code":"17944","type":"CDM"},{"code":"985","type":"RC"},{"code":"93227","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.48,"discounted_cash":32.24,"setting":"both","billing_class":"facility"}]},{"description":"STRESS ECHO INT/RPT","code_information":[{"code":"17945","type":"CDM"},{"code":"985","type":"RC"},{"code":"93350","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":970.02,"discounted_cash":485.01,"setting":"both","billing_class":"facility"}]},{"description":"TTE W/DOPPLER CMP PF","code_information":[{"code":"17946","type":"CDM"},{"code":"985","type":"RC"},{"code":"93306","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.88,"discounted_cash":130.94,"setting":"both","billing_class":"facility"}]},{"description":"ECHO DOPPLER CMP PF","code_information":[{"code":"17947","type":"CDM"},{"code":"985","type":"RC"},{"code":"93320","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":43.94,"discounted_cash":21.97,"setting":"both","billing_class":"facility"}]},{"description":"ECHO COLOR DOP PF","code_information":[{"code":"17948","type":"CDM"},{"code":"985","type":"RC"},{"code":"93325","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.78,"discounted_cash":4.39,"setting":"both","billing_class":"facility"}]},{"description":"ECHO D&M LIMITED PF","code_information":[{"code":"17949","type":"CDM"},{"code":"985","type":"RC"},{"code":"93308","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":388.06,"discounted_cash":194.03,"setting":"both","billing_class":"facility"}]},{"description":"PERFLUTREN LIPID 1ML","code_information":[{"code":"17950","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.15,"discounted_cash":192.07,"setting":"both","billing_class":"facility"}]},{"description":"EKG TRACING CARD RHB","code_information":[{"code":"17992","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":214.3,"discounted_cash":107.15,"setting":"both","billing_class":"facility"}]},{"description":"STRESS TEST TRACING","code_information":[{"code":"17993","type":"CDM"},{"code":"482","type":"RC"},{"code":"93017","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1169.8,"discounted_cash":584.9,"setting":"both","billing_class":"facility"}]},{"description":"CR NON-EKG EXERCISE","code_information":[{"code":"17994","type":"CDM"},{"code":"943","type":"RC"},{"code":"93797","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":423.1,"discounted_cash":211.55,"setting":"both","billing_class":"facility"}]},{"description":"CR MONITORED EXERCIS","code_information":[{"code":"17995","type":"CDM"},{"code":"943","type":"RC"},{"code":"93798","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":423.1,"discounted_cash":211.55,"setting":"both","billing_class":"facility"}]},{"description":"PULMON REHAD ASSESS","code_information":[{"code":"17996","type":"CDM"},{"code":"410","type":"RC"},{"code":"94799","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":508.75,"discounted_cash":254.38,"setting":"both","billing_class":"facility"}]},{"description":"PULSE OX SINGLE","code_information":[{"code":"17997","type":"CDM"},{"code":"460","type":"RC"},{"code":"94760","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":15.63,"setting":"both","billing_class":"facility"}]},{"description":"FINGERSTICK GLUCOSE","code_information":[{"code":"17998","type":"CDM"},{"code":"301","type":"RC"},{"code":"82948","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.55,"discounted_cash":13.78,"setting":"both","billing_class":"facility"}]},{"description":"NEG PRES WND TX <50","code_information":[{"code":"18","type":"CDM"},{"code":"761","type":"RC"},{"code":"97605","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":556.6,"discounted_cash":278.3,"setting":"both","billing_class":"facility"}]},{"description":"FCM FLW CYTO TC EAAD","code_information":[{"code":"182","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":195.65,"discounted_cash":97.83,"setting":"both","billing_class":"facility"}]},{"description":"CATH PTCA EMERGE VAR","code_information":[{"code":"18240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":275.9,"discounted_cash":137.95,"setting":"both","billing_class":"facility"}]},{"description":"COIL AZURE DETACH","code_information":[{"code":"18241","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.35,"discounted_cash":1101.17,"setting":"both","billing_class":"facility"}]},{"description":"CATH ANGIO GLIDE CGS","code_information":[{"code":"18242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":163.25,"discounted_cash":81.63,"setting":"both","billing_class":"facility"}]},{"description":"PLUG AMPLATZER 9AVP2","code_information":[{"code":"18243","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2284.8,"discounted_cash":1142.4,"setting":"both","billing_class":"facility"}]},{"description":"LINQII INS CRD MONIT","code_information":[{"code":"18244","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1764","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":8770.0,"discounted_cash":4385.0,"setting":"both","billing_class":"facility"}]},{"description":"CATH HI FLOW 5.0","code_information":[{"code":"18245","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":79.75,"discounted_cash":39.88,"setting":"both","billing_class":"facility"}]},{"description":"CATH TORCON NB ADV 5","code_information":[{"code":"18246","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.25,"discounted_cash":29.63,"setting":"both","billing_class":"facility"}]},{"description":"CATH RENAL 65CM","code_information":[{"code":"18247","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1758","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.25,"discounted_cash":58.13,"setting":"both","billing_class":"facility"}]},{"description":"CPR","code_information":[{"code":"18248","type":"CDM"},{"code":"480","type":"RC"},{"code":"92950","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.7,"discounted_cash":441.85,"setting":"both","billing_class":"facility"}]},{"description":"MECH THROMBECTOMY","code_information":[{"code":"18250","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1787.75,"discounted_cash":893.88,"setting":"both","billing_class":"facility"}]},{"description":"CARDIOVERSION EXTRNL","code_information":[{"code":"18251","type":"CDM"},{"code":"480","type":"RC"},{"code":"92960","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1607.0,"discounted_cash":803.5,"setting":"both","billing_class":"facility"}]},{"description":"IVUS INIT VESSEL","code_information":[{"code":"18252","type":"CDM"},{"code":"481","type":"RC"},{"code":"92978","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1870.1,"discounted_cash":935.05,"setting":"both","billing_class":"facility"}]},{"description":"IVUS ADDL VESSEL","code_information":[{"code":"18253","type":"CDM"},{"code":"481","type":"RC"},{"code":"92979","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1870.1,"discounted_cash":935.05,"setting":"both","billing_class":"facility"}]},{"description":"PACEMKR PLCMT VENTR","code_information":[{"code":"18258","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":17538.45,"discounted_cash":8769.23,"setting":"both","billing_class":"facility"}]},{"description":"PACEMKR PLCMT ATR&","code_information":[{"code":"18259","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":24217.85,"discounted_cash":12108.92,"setting":"both","billing_class":"facility"}]},{"description":"RPS PM DFB LEAD","code_information":[{"code":"18262","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":3333.05,"discounted_cash":1666.53,"setting":"both","billing_class":"facility"}]},{"description":"INS CATH 1ST ORD ABD","code_information":[{"code":"18265","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1787.75,"discounted_cash":893.88,"setting":"both","billing_class":"facility"}]},{"description":"INS CATH RENL 1ST UN","code_information":[{"code":"18266","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":6437.4,"discounted_cash":3218.7,"setting":"both","billing_class":"facility"}]},{"description":"RENAL ANGIO","code_information":[{"code":"18267","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":6437.4,"discounted_cash":3218.7,"setting":"both","billing_class":"facility"}]},{"description":"PLC OCCLUSIVE DEVICE","code_information":[{"code":"18275","type":"CDM"},{"code":"481","type":"RC"},{"code":"G0269","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1787.75,"discounted_cash":893.88,"setting":"both","billing_class":"facility"}]},{"description":"PERICRDICENTSIS INTL","code_information":[{"code":"18277","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2168.35,"discounted_cash":1084.17,"setting":"both","billing_class":"facility"}]},{"description":"PACEMKR PLCMT ATRIAL","code_information":[{"code":"18278","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":17538.45,"discounted_cash":8769.23,"setting":"both","billing_class":"facility"}]},{"description":"SP LOOP RECRDR PLMNT","code_information":[{"code":"18279","type":"CDM"},{"code":"480","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":10856.9,"discounted_cash":5428.45,"setting":"both","billing_class":"facility"}]},{"description":"SP LOOP RCRDR REPMNT","code_information":[{"code":"18281","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2231.45,"discounted_cash":1115.72,"setting":"both","billing_class":"facility"}]},{"description":"RIGHT HEART CATH","code_information":[{"code":"18282","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":8083.35,"discounted_cash":4041.68,"setting":"both","billing_class":"facility"}]},{"description":"LHC NO CORS","code_information":[{"code":"18283","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":8084.7,"discounted_cash":4042.35,"setting":"both","billing_class":"facility"}]},{"description":"R/LHC NO CORS","code_information":[{"code":"18284","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":13260.85,"discounted_cash":6630.43,"setting":"both","billing_class":"facility"}]},{"description":"CORONARY ANGIO ONLY","code_information":[{"code":"18285","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":8083.35,"discounted_cash":4041.68,"setting":"both","billing_class":"facility"}]},{"description":"CORS + GRAFTS ONLY","code_information":[{"code":"18286","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":8084.7,"discounted_cash":4042.35,"setting":"both","billing_class":"facility"}]},{"description":"RHC + CORS ONLY","code_information":[{"code":"18287","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":11783.75,"discounted_cash":5891.88,"setting":"both","billing_class":"facility"}]},{"description":"RHC CORS + GRFT ONLY","code_information":[{"code":"18288","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":12836.05,"discounted_cash":6418.02,"setting":"both","billing_class":"facility"}]},{"description":"LHC + CORS","code_information":[{"code":"18289","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":8084.7,"discounted_cash":4042.35,"setting":"both","billing_class":"facility"}]},{"description":"LHC CORS + GRAFTS","code_information":[{"code":"18290","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":8084.7,"discounted_cash":4042.35,"setting":"both","billing_class":"facility"}]},{"description":"R/LHC + CORS","code_information":[{"code":"18291","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":13871.9,"discounted_cash":6935.95,"setting":"both","billing_class":"facility"}]},{"description":"R/LHC + CORS +GRAFTS","code_information":[{"code":"18292","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":13260.85,"discounted_cash":6630.43,"setting":"both","billing_class":"facility"}]},{"description":"AORTIC ROOT INJ","code_information":[{"code":"18294","type":"CDM"},{"code":"481","type":"RC"},{"code":"93567","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.2,"discounted_cash":440.6,"setting":"both","billing_class":"facility"}]},{"description":"RMV/RPL PM GEN SGL","code_information":[{"code":"18298","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":15150.4,"discounted_cash":7575.2,"setting":"both","billing_class":"facility"}]},{"description":"RMV/RPL PM GEN DUAL","code_information":[{"code":"18299","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":16677.55,"discounted_cash":8338.77,"setting":"both","billing_class":"facility"}]},{"description":"FCM FLW CYTO TC 1ST","code_information":[{"code":"183","type":"CDM"},{"code":"311","type":"RC"},{"code":"88184","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":514.45,"discounted_cash":257.23,"setting":"both","billing_class":"facility"}]},{"description":"RMV/RPL PM GEN MLT","code_information":[{"code":"18300","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":27983.6,"discounted_cash":13991.8,"setting":"both","billing_class":"facility"}]},{"description":"INS IABP DEVICE","code_information":[{"code":"18301","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2662.55,"discounted_cash":1331.28,"setting":"both","billing_class":"facility"}]},{"description":"REMOVE IABP DEVICE","code_information":[{"code":"18302","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1272.65,"discounted_cash":636.33,"setting":"both","billing_class":"facility"}]},{"description":"ADAPTER Y PLUS","code_information":[{"code":"18312","type":"CDM"},{"code":"272","type":"RC"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":85.4,"discounted_cash":42.7,"setting":"both","billing_class":"facility"}]},{"description":"CATH DIAG 4 FR VARIO","code_information":[{"code":"18313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":21.5,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDE RUNAWAY","code_information":[{"code":"18314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":149.95,"discounted_cash":74.97,"setting":"both","billing_class":"facility"}]},{"description":"CATH MICRO CORANARY","code_information":[{"code":"18315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1273.4,"discounted_cash":636.7,"setting":"both","billing_class":"facility"}]},{"description":"RHC ONLY CONGENITAL","code_information":[{"code":"18321","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":7727.25,"discounted_cash":3863.63,"setting":"both","billing_class":"facility"}]},{"description":"RHC+RETROGRADE LH","code_information":[{"code":"18322","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":7727.25,"discounted_cash":3863.63,"setting":"both","billing_class":"facility"}]},{"description":"RHC+TRANSEPTAL LHC","code_information":[{"code":"18323","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":7727.25,"discounted_cash":3863.63,"setting":"both","billing_class":"facility"}]},{"description":"RHC+TRANSEPTAL LHC V","code_information":[{"code":"18324","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":7727.25,"discounted_cash":3863.63,"setting":"both","billing_class":"facility"}]},{"description":"INJ PRCD SLCT CORON","code_information":[{"code":"18325","type":"CDM"},{"code":"481","type":"RC"},{"code":"93563","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1787.75,"discounted_cash":893.88,"setting":"both","billing_class":"facility"}]},{"description":"INJ SELCT BYPASS GRT","code_information":[{"code":"18326","type":"CDM"},{"code":"481","type":"RC"},{"code":"93564","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1787.75,"discounted_cash":893.88,"setting":"both","billing_class":"facility"}]},{"description":"INJ LT VENT ATRL ANG","code_information":[{"code":"18327","type":"CDM"},{"code":"481","type":"RC"},{"code":"93565","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1787.75,"discounted_cash":893.88,"setting":"both","billing_class":"facility"}]},{"description":"SLCT RT VENT ATR ANG","code_information":[{"code":"18328","type":"CDM"},{"code":"481","type":"RC"},{"code":"93566","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1787.75,"discounted_cash":893.88,"setting":"both","billing_class":"facility"}]},{"description":"PULMONARY ANGIOGRAPH","code_information":[{"code":"18329","type":"CDM"},{"code":"481","type":"RC"},{"code":"93568","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1787.75,"discounted_cash":893.88,"setting":"both","billing_class":"facility"}]},{"description":"GASTROEPIPLOC","code_information":[{"code":"18330","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2075.15,"discounted_cash":1037.58,"setting":"both","billing_class":"facility"}]},{"description":"S&I CERVIAL CARTD UN","code_information":[{"code":"18331","type":"CDM"},{"code":"323","type":"RC"},{"code":"75710","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":6437.4,"discounted_cash":3218.7,"setting":"both","billing_class":"facility"}]},{"description":"S&I CERVIAL CARTD BI","code_information":[{"code":"18332","type":"CDM"},{"code":"323","type":"RC"},{"code":"75716","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":6437.4,"discounted_cash":3218.7,"setting":"both","billing_class":"facility"}]},{"description":"PCI SINGLE GRAFT","code_information":[{"code":"18333","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":23640.45,"discounted_cash":11820.23,"setting":"both","billing_class":"facility"}]},{"description":"PCI OF/THRU BYPSSGRT","code_information":[{"code":"18334","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":13297.75,"discounted_cash":6648.88,"setting":"both","billing_class":"facility"}]},{"description":"AMI W/REVASCULARIZAT","code_information":[{"code":"18335","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":24729.75,"discounted_cash":12364.88,"setting":"both","billing_class":"facility"}]},{"description":"CTO ARTRY,BRNCH,BYP","code_information":[{"code":"18336","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":23640.45,"discounted_cash":11820.23,"setting":"both","billing_class":"facility"}]},{"description":"CTO EA ADDL ARTRY BR","code_information":[{"code":"18337","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":13297.75,"discounted_cash":6648.88,"setting":"both","billing_class":"facility"}]},{"description":"ATHERECTOMY W PTCA","code_information":[{"code":"18338","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":23640.45,"discounted_cash":11820.23,"setting":"both","billing_class":"facility"}]},{"description":"ATHERECTOMY","code_information":[{"code":"18339","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":17916.55,"discounted_cash":8958.27,"setting":"both","billing_class":"facility"}]},{"description":"PULMONIC BALLOON","code_information":[{"code":"18341","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":23640.45,"discounted_cash":11820.23,"setting":"both","billing_class":"facility"}]},{"description":"MITRAL BALLOON","code_information":[{"code":"18342","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":23640.45,"discounted_cash":11820.23,"setting":"both","billing_class":"facility"}]},{"description":"ENDOMYOCRDIAL BIOPSY","code_information":[{"code":"18343","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":6437.4,"discounted_cash":3218.7,"setting":"both","billing_class":"facility"}]},{"description":"ERGONOVINE PROVOCAT","code_information":[{"code":"18344","type":"CDM"},{"code":"730","type":"RC"},{"code":"93024","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":878.75,"discounted_cash":439.38,"setting":"both","billing_class":"facility"}]},{"description":"PERICRDICENTSIS SUBS","code_information":[{"code":"18345","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2072.85,"discounted_cash":1036.42,"setting":"both","billing_class":"facility"}]},{"description":"TEMP PACER INSERT","code_information":[{"code":"18346","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":17691.15,"discounted_cash":8845.58,"setting":"both","billing_class":"facility"}]},{"description":"FLUROSCOPY UPTO 1HR","code_information":[{"code":"18347","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":859.25,"discounted_cash":429.63,"setting":"both","billing_class":"facility"}]},{"description":"THROMBLYSIS INTRACOR","code_information":[{"code":"18348","type":"CDM"},{"code":"481","type":"RC"},{"code":"92975","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":6719.5,"discounted_cash":3359.75,"setting":"both","billing_class":"facility"}]},{"description":"INSERT CATHETH ARTRY","code_information":[{"code":"18349","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1787.75,"discounted_cash":893.88,"setting":"both","billing_class":"facility"}]},{"description":"INS NONTUNNNEL CVC","code_information":[{"code":"18350","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2072.85,"discounted_cash":1036.42,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND GUIDANCE","code_information":[{"code":"18351","type":"CDM"},{"code":"402","type":"RC"},{"code":"76937","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":284.8,"discounted_cash":142.4,"setting":"both","billing_class":"facility"}]},{"description":"FLUROSCOPY GUIDANCE","code_information":[{"code":"18352","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":822.15,"discounted_cash":411.07,"setting":"both","billing_class":"facility"}]},{"description":"SWAN GANZ PLACEMENT","code_information":[{"code":"18353","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2072.85,"discounted_cash":1036.42,"setting":"both","billing_class":"facility"}]},{"description":"PHARMACO AGENT ADMN","code_information":[{"code":"18354","type":"CDM"},{"code":"481","type":"RC"},{"code":"93463","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1787.75,"discounted_cash":893.88,"setting":"both","billing_class":"facility"}]},{"description":"EXTREMITY UNILATERAL","code_information":[{"code":"18355","type":"CDM"},{"code":"323","type":"RC"},{"code":"75710","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":6734.05,"discounted_cash":3367.03,"setting":"both","billing_class":"facility"}]},{"description":"EXTREMITY BILAT ANGI","code_information":[{"code":"18356","type":"CDM"},{"code":"323","type":"RC"},{"code":"75716","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":6437.4,"discounted_cash":3218.7,"setting":"both","billing_class":"facility"}]},{"description":"AORTOGRAPHY ABDOMINL","code_information":[{"code":"18357","type":"CDM"},{"code":"323","type":"RC"},{"code":"75625","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":6437.4,"discounted_cash":3218.7,"setting":"both","billing_class":"facility"}]},{"description":"AORTOGRAPHY W RUNOFF","code_information":[{"code":"18358","type":"CDM"},{"code":"323","type":"RC"},{"code":"75630","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":6437.4,"discounted_cash":3218.7,"setting":"both","billing_class":"facility"}]},{"description":"ESTBLSH ACCSS ARTERY","code_information":[{"code":"18359","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1589.55,"discounted_cash":794.77,"setting":"both","billing_class":"facility"}]},{"description":"INTRO CATHETER AORTA","code_information":[{"code":"18360","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1316.05,"discounted_cash":658.02,"setting":"both","billing_class":"facility"}]},{"description":"INS CATH SECOND ORDR","code_information":[{"code":"18361","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1908.1,"discounted_cash":954.05,"setting":"both","billing_class":"facility"}]},{"description":"INS CATH THIRD ORDER","code_information":[{"code":"18362","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2075.15,"discounted_cash":1037.58,"setting":"both","billing_class":"facility"}]},{"description":"INS CATH EA ADDL VES","code_information":[{"code":"18363","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":868.45,"discounted_cash":434.23,"setting":"both","billing_class":"facility"}]},{"description":"S&I ADD'L VESSEL","code_information":[{"code":"18364","type":"CDM"},{"code":"323","type":"RC"},{"code":"75774","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1647.2,"discounted_cash":823.6,"setting":"both","billing_class":"facility"}]},{"description":"1ST ORDR THORAC/BRAC","code_information":[{"code":"18365","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1106.95,"discounted_cash":553.48,"setting":"both","billing_class":"facility"}]},{"description":"2ND ORDER THORC/BRAC","code_information":[{"code":"18366","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1445.05,"discounted_cash":722.52,"setting":"both","billing_class":"facility"}]},{"description":"3RD ORDER THORC/BRAC","code_information":[{"code":"18367","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1150.5,"discounted_cash":575.25,"setting":"both","billing_class":"facility"}]},{"description":"ILLIAC PTA PRIMARY","code_information":[{"code":"18368","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":13158.75,"discounted_cash":6579.38,"setting":"both","billing_class":"facility"}]},{"description":"ILLIAC PTA SECONDARY","code_information":[{"code":"18369","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":13158.75,"discounted_cash":6579.38,"setting":"both","billing_class":"facility"}]},{"description":"ILLIAC STENT PRIMARY","code_information":[{"code":"18370","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":23640.45,"discounted_cash":11820.23,"setting":"both","billing_class":"facility"}]},{"description":"ILLIAC STENT SECOND","code_information":[{"code":"18371","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":11820.2,"discounted_cash":5910.1,"setting":"both","billing_class":"facility"}]},{"description":"FEMORL/POPLTEAL PTA","code_information":[{"code":"18372","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":13158.75,"discounted_cash":6579.38,"setting":"both","billing_class":"facility"}]},{"description":"FEMORL/POPTL ATHEREC","code_information":[{"code":"18373","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":23640.45,"discounted_cash":11820.23,"setting":"both","billing_class":"facility"}]},{"description":"FEMRAL/POPTEAL STENT","code_information":[{"code":"18374","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":23640.45,"discounted_cash":11820.23,"setting":"both","billing_class":"facility"}]},{"description":"FMORL/POPTL ATHER ST","code_information":[{"code":"18375","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":31353.8,"discounted_cash":15676.9,"setting":"both","billing_class":"facility"}]},{"description":"TIBIAL/PERNEAL PTA P","code_information":[{"code":"18376","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":23640.45,"discounted_cash":11820.23,"setting":"both","billing_class":"facility"}]},{"description":"TIBIAL/PERNEAL PTA S","code_information":[{"code":"18377","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":11820.2,"discounted_cash":5910.1,"setting":"both","billing_class":"facility"}]},{"description":"TBIAL/PRNEAL ATHER P","code_information":[{"code":"18378","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":31353.8,"discounted_cash":15676.9,"setting":"both","billing_class":"facility"}]},{"description":"TBIAL/PERNEAL ARTH S","code_information":[{"code":"18379","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":15676.9,"discounted_cash":7838.45,"setting":"both","billing_class":"facility"}]},{"description":"TBIAL/PERNEAL STNT P","code_information":[{"code":"18380","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":32798.55,"discounted_cash":16399.28,"setting":"both","billing_class":"facility"}]},{"description":"TBIAL/PERNEAL ST SEC","code_information":[{"code":"18381","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":15676.9,"discounted_cash":7838.45,"setting":"both","billing_class":"facility"}]},{"description":"TBIAL/PERNEL ATHER P","code_information":[{"code":"18382","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":31353.8,"discounted_cash":15676.9,"setting":"both","billing_class":"facility"}]},{"description":"TBIAL/PERNEL ATHER S","code_information":[{"code":"18383","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":15676.9,"discounted_cash":7838.45,"setting":"both","billing_class":"facility"}]},{"description":"CATH  LOCM 300-399MG","code_information":[{"code":"18384","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":1.07,"setting":"both","billing_class":"facility"}]},{"description":"MOD SEDATION INTL 15","code_information":[{"code":"18385","type":"CDM"},{"code":"371","type":"RC"},{"code":"99152","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":305.55,"discounted_cash":152.78,"setting":"both","billing_class":"facility"}]},{"description":"MOD SEDATION ADD 15M","code_information":[{"code":"18386","type":"CDM"},{"code":"371","type":"RC"},{"code":"99153","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":203.95,"discounted_cash":101.97,"setting":"both","billing_class":"facility"}]},{"description":"STENT ILIOFEM VARIOU","code_information":[{"code":"18387","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":4167.45,"discounted_cash":2083.72,"setting":"both","billing_class":"facility"}]},{"description":"PTCA ONLY SINGLE","code_information":[{"code":"18388","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":13765.15,"discounted_cash":6882.57,"setting":"both","billing_class":"facility"}]},{"description":"PTCA EA ADDTL VESSEL","code_information":[{"code":"18389","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":6882.4,"discounted_cash":3441.2,"setting":"both","billing_class":"facility"}]},{"description":"CARDIAC ATHER EA ADD","code_information":[{"code":"18390","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":13297.75,"discounted_cash":6648.88,"setting":"both","billing_class":"facility"}]},{"description":"PCI SINGLE VESSEL","code_information":[{"code":"18391","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":23640.45,"discounted_cash":11820.23,"setting":"both","billing_class":"facility"}]},{"description":"PCI OF ADDTL VESSEL","code_information":[{"code":"18392","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":13910.6,"discounted_cash":6955.3,"setting":"both","billing_class":"facility"}]},{"description":"CARD ATHER/ANG/STENT","code_information":[{"code":"18393","type":"CDM"},{"code":"481","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":31353.8,"discounted_cash":15676.9,"setting":"both","billing_class":"facility"}]},{"description":"THORACIC AORTOGRM","code_information":[{"code":"18394","type":"CDM"},{"code":"323","type":"RC"},{"code":"75605","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":10701.95,"discounted_cash":5350.98,"setting":"both","billing_class":"facility"}]},{"description":"IFR / FFR","code_information":[{"code":"18395","type":"CDM"},{"code":"481","type":"RC"},{"code":"93571","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1870.1,"discounted_cash":935.05,"setting":"both","billing_class":"facility"}]},{"description":"PULMNRY ANGIO BIL","code_information":[{"code":"18396","type":"CDM"},{"code":"323","type":"RC"},{"code":"75743","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":9656.05,"discounted_cash":4828.02,"setting":"both","billing_class":"facility"}]},{"description":"PULMNRY ANGIO UNI","code_information":[{"code":"18397","type":"CDM"},{"code":"323","type":"RC"},{"code":"75741","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":6437.4,"discounted_cash":3218.7,"setting":"both","billing_class":"facility"}]},{"description":"FFR ADD VESSEL","code_information":[{"code":"18398","type":"CDM"},{"code":"481","type":"RC"},{"code":"93572","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":935.0,"discounted_cash":467.5,"setting":"both","billing_class":"facility"}]},{"description":"GDEWIRE PT FLOOPY J","code_information":[{"code":"18399","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":111.5,"setting":"both","billing_class":"facility"}]},{"description":"GDEWIRE FLOOPY J","code_information":[{"code":"18400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":111.5,"setting":"both","billing_class":"facility"}]},{"description":"GDEWIRE GUIDEZILLA","code_information":[{"code":"18401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1133.25,"discounted_cash":566.63,"setting":"both","billing_class":"facility"}]},{"description":"GDEWIRE HT 190 BMWJ","code_information":[{"code":"18402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.75,"discounted_cash":124.88,"setting":"both","billing_class":"facility"}]},{"description":"GDEWIRE HT 300 BMWJ","code_information":[{"code":"18403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":252.95,"discounted_cash":126.47,"setting":"both","billing_class":"facility"}]},{"description":"GDEWIRE 190 WHISPER","code_information":[{"code":"18404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":251.05,"discounted_cash":125.53,"setting":"both","billing_class":"facility"}]},{"description":"EXTENSION DOC 145CM","code_information":[{"code":"18405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":226.6,"discounted_cash":113.3,"setting":"both","billing_class":"facility"}]},{"description":"GDEWIRE HT PILOT 50J","code_information":[{"code":"18406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":247.25,"discounted_cash":123.63,"setting":"both","billing_class":"facility"}]},{"description":"GDEWIRE ASAHI PRO J","code_information":[{"code":"18407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":249.7,"discounted_cash":124.85,"setting":"both","billing_class":"facility"}]},{"description":"STENT SYSTEM GM 2.8","code_information":[{"code":"18408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":4354.2,"discounted_cash":2177.1,"setting":"both","billing_class":"facility"}]},{"description":"STENT SYSTEM GM 3.5","code_information":[{"code":"18409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":4354.2,"discounted_cash":2177.1,"setting":"both","billing_class":"facility"}]},{"description":"STENT SYSTEM GM 4.0","code_information":[{"code":"18410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":4354.2,"discounted_cash":2177.1,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE STATLOCK IABP","code_information":[{"code":"18411","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.35,"discounted_cash":29.68,"setting":"both","billing_class":"facility"}]},{"description":"CATH EAGLE EYE .014","code_information":[{"code":"18412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1753","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1561.4,"discounted_cash":780.7,"setting":"both","billing_class":"facility"}]},{"description":"WIRE VERRATA FFR","code_information":[{"code":"18413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1399.25,"discounted_cash":699.63,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX 2.25MM X08MM","code_information":[{"code":"18414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2258.65,"discounted_cash":1129.33,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX 2.25MMX12MM","code_information":[{"code":"18415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX 2.25MM X15MM","code_information":[{"code":"18416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.25MM X 18MM","code_information":[{"code":"18417","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.25MM X 23MM","code_information":[{"code":"18418","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.25MM X 28MM","code_information":[{"code":"18419","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.5MM X 08MM","code_information":[{"code":"18420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.5MM X 12MM","code_information":[{"code":"18421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.5MM X 15MM","code_information":[{"code":"18422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.5MM X 18MM","code_information":[{"code":"18423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.5MM X 23MM","code_information":[{"code":"18424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.5MM X 28MM","code_information":[{"code":"18425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.5MM X 33MM","code_information":[{"code":"18426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX 2.5MM X 38MM","code_information":[{"code":"18427","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.75MM X 08MM","code_information":[{"code":"18428","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX 2.75MM X 12M","code_information":[{"code":"18429","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.75MM X 15MM","code_information":[{"code":"18430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.75MM X 18MM","code_information":[{"code":"18431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.75MM X 23MM","code_information":[{"code":"18432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX 2.75MM X 28M","code_information":[{"code":"18433","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.75MM X 33MM","code_information":[{"code":"18434","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX2.75MM X 38MM","code_information":[{"code":"18435","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.0MM X 08MM","code_information":[{"code":"18436","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.0MM X 12MM","code_information":[{"code":"18437","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX 3.0MMX15MM","code_information":[{"code":"18438","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.0MM X 18MM","code_information":[{"code":"18439","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.0MM X 23MM","code_information":[{"code":"18440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.0MM X 28MM","code_information":[{"code":"18441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.0MM X 33MM","code_information":[{"code":"18442","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.0MM X 38MM","code_information":[{"code":"18443","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.25MM X 08MM","code_information":[{"code":"18444","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.25MM X 12MM","code_information":[{"code":"18445","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.25MM X 15MM","code_information":[{"code":"18446","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.25MM X 18MM","code_information":[{"code":"18447","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.25MM X 23MM","code_information":[{"code":"18448","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.25MM X 28MM","code_information":[{"code":"18449","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.25MM X 33MM","code_information":[{"code":"18450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.25MM X 38MM","code_information":[{"code":"18451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.5MM X 08MM","code_information":[{"code":"18452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.5MM X 12MM","code_information":[{"code":"18453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.5MM X 15MM","code_information":[{"code":"18454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.5MM X 18MM","code_information":[{"code":"18455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.5MM X 23MM","code_information":[{"code":"18456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.5MM X 28MM","code_information":[{"code":"18457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.5MM X 33MM","code_information":[{"code":"18458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX3.5MM X 38MM","code_information":[{"code":"18459","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX4.0MM X 08MM","code_information":[{"code":"18460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2296.45,"discounted_cash":1148.22,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX4.0MM X 12MM","code_information":[{"code":"18461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX4.0MM  X 15MM","code_information":[{"code":"18462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX4.0MM X 18MM","code_information":[{"code":"18463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX4.0MM X 23MM","code_information":[{"code":"18464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX4.0MM X 28MM","code_information":[{"code":"18465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX4.0MM X 33MM","code_information":[{"code":"18466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"STENTRX4.0MM X 38MM","code_information":[{"code":"18467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2195.3,"discounted_cash":1097.65,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLN ANGIOSCULPT","code_information":[{"code":"18468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2315.25,"discounted_cash":1157.63,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLN SPRINTER RX","code_information":[{"code":"18469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":312.15,"discounted_cash":156.07,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDE LAUNCHER","code_information":[{"code":"18470","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":134.65,"discounted_cash":67.33,"setting":"both","billing_class":"facility"}]},{"description":"STENT RESOLUTE INTER","code_information":[{"code":"18471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1877.4,"discounted_cash":938.7,"setting":"both","billing_class":"facility"}]},{"description":"STENT INTERGRITY BM","code_information":[{"code":"18472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1128.45,"discounted_cash":564.23,"setting":"both","billing_class":"facility"}]},{"description":"WIRE FILTER","code_information":[{"code":"18473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2330.75,"discounted_cash":1165.38,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE COMP PRELUDE","code_information":[{"code":"18474","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.4,"discounted_cash":43.2,"setting":"both","billing_class":"facility"}]},{"description":"CABLE PACING DISP","code_information":[{"code":"18475","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.65,"discounted_cash":31.32,"setting":"both","billing_class":"facility"}]},{"description":"INDEFLATOR BLUE DIAM","code_information":[{"code":"18476","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":146.65,"discounted_cash":73.33,"setting":"both","billing_class":"facility"}]},{"description":"PK ANGIO ACCESS","code_information":[{"code":"18477","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":43.8,"discounted_cash":21.9,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVE CONTAMINATION","code_information":[{"code":"18478","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.6,"discounted_cash":18.8,"setting":"both","billing_class":"facility"}]},{"description":"KIT MANIFOLD","code_information":[{"code":"18479","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.2,"discounted_cash":52.1,"setting":"both","billing_class":"facility"}]},{"description":"CATH BALN 40CC 7.5FR","code_information":[{"code":"18480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.2,"discounted_cash":1018.1,"setting":"both","billing_class":"facility"}]},{"description":"CATH BALN 50CC 8FR","code_information":[{"code":"18481","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2130.1,"discounted_cash":1065.05,"setting":"both","billing_class":"facility"}]},{"description":"CATH 5FR 3DRC","code_information":[{"code":"18482","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":17.13,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING AL1","code_information":[{"code":"18483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING AL2","code_information":[{"code":"18484","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING AR2","code_information":[{"code":"18485","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":17.13,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING IM100","code_information":[{"code":"18486","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":17.13,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING MPA2","code_information":[{"code":"18487","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING MPA1","code_information":[{"code":"18488","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING AR1","code_information":[{"code":"18489","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":17.13,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING AR 100","code_information":[{"code":"18490","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":17.13,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING RCB 100","code_information":[{"code":"18491","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING JR 4X10","code_information":[{"code":"18492","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":17.13,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING LCB 100","code_information":[{"code":"18493","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":17.13,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING JL 3.5","code_information":[{"code":"18494","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":17.13,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING JL 4","code_information":[{"code":"18495","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING JL 4.5","code_information":[{"code":"18496","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":17.13,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING JL 5","code_information":[{"code":"18497","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING PIG 110","code_information":[{"code":"18498","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":17.13,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE STATLOCK","code_information":[{"code":"18499","type":"CDM"},{"code":"272","type":"RC"},{"code":"A5200","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.6,"discounted_cash":10.3,"setting":"both","billing_class":"facility"}]},{"description":"KIT PERICARDIO 6FR","code_information":[{"code":"18500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":232.75,"discounted_cash":116.38,"setting":"both","billing_class":"facility"}]},{"description":"KIT REVEAL LINQ","code_information":[{"code":"18501","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":276.35,"discounted_cash":138.18,"setting":"both","billing_class":"facility"}]},{"description":"LOOP RECORDER","code_information":[{"code":"18502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1764","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":8350.7,"discounted_cash":4175.35,"setting":"both","billing_class":"facility"}]},{"description":"MICROSPHERES ONCOZEN","code_information":[{"code":"18503","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1764","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2877.5,"discounted_cash":1438.75,"setting":"both","billing_class":"facility"}]},{"description":"MICROSPHERES ONCOZEN","code_information":[{"code":"18504","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1764","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":4795.85,"discounted_cash":2397.93,"setting":"both","billing_class":"facility"}]},{"description":"HEMOSTAT FLOWABLE D","code_information":[{"code":"18505","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1764","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":338.35,"discounted_cash":169.18,"setting":"both","billing_class":"facility"}]},{"description":"GLIDEWIRE GT 0.016 1","code_information":[{"code":"18506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":672.8,"discounted_cash":336.4,"setting":"both","billing_class":"facility"}]},{"description":"MICROCATH PROGT 2.8F","code_information":[{"code":"18507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1253.45,"discounted_cash":626.73,"setting":"both","billing_class":"facility"}]},{"description":"GLIDESHEATH ACCESS K","code_information":[{"code":"18508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":312.8,"discounted_cash":156.4,"setting":"both","billing_class":"facility"}]},{"description":"KIT GLIDESHEATH SLEN","code_information":[{"code":"18509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":369.4,"discounted_cash":184.7,"setting":"both","billing_class":"facility"}]},{"description":"CATH DIAG VARIOUS","code_information":[{"code":"18510","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":28.1,"discounted_cash":14.05,"setting":"both","billing_class":"facility"}]},{"description":"CATH DIAG TERUMO","code_information":[{"code":"18511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":123.75,"discounted_cash":61.88,"setting":"both","billing_class":"facility"}]},{"description":"CATH ASPIRATION 6FR","code_information":[{"code":"18512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1057.3,"discounted_cash":528.65,"setting":"both","billing_class":"facility"}]},{"description":"TILT TABLE STUDY","code_information":[{"code":"18513","type":"CDM"},{"code":"480","type":"RC"},{"code":"93660","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1450.1,"discounted_cash":725.05,"setting":"both","billing_class":"facility"}]},{"description":"CATH CORONARY VAR","code_information":[{"code":"18514","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":373.3,"discounted_cash":186.65,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM LEAD SGL G38","code_information":[{"code":"18515","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1779","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2427.25,"discounted_cash":1213.63,"setting":"both","billing_class":"facility"}]},{"description":"PACEMAKER ACCOLADE","code_information":[{"code":"18516","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":10789.95,"discounted_cash":5394.98,"setting":"both","billing_class":"facility"}]},{"description":"GDEWIRE RT FLOPPY","code_information":[{"code":"18517","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":296.85,"discounted_cash":148.43,"setting":"both","billing_class":"facility"}]},{"description":"STENT DE RESLTE VARI","code_information":[{"code":"18518","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2099.85,"discounted_cash":1049.92,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA VENOM 18GA","code_information":[{"code":"18519","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":512.75,"discounted_cash":256.38,"setting":"both","billing_class":"facility"}]},{"description":"ELECTRODE NEUT","code_information":[{"code":"18520","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":67.9,"discounted_cash":33.95,"setting":"both","billing_class":"facility"}]},{"description":"ADAPTER CELLULAR","code_information":[{"code":"18521","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":715.45,"discounted_cash":357.73,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING IKARI","code_information":[{"code":"18522","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":305.75,"discounted_cash":152.88,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE VARIOUS SZ","code_information":[{"code":"18523","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility"}]},{"description":"GLIDESHEATH 60-1065","code_information":[{"code":"18524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":174.5,"discounted_cash":87.25,"setting":"both","billing_class":"facility"}]},{"description":"GLIDESHEATH 40-2560","code_information":[{"code":"18525","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.85,"discounted_cash":62.42,"setting":"both","billing_class":"facility"}]},{"description":"CATH DUAL LUMEN LANG","code_information":[{"code":"18526","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":464.2,"discounted_cash":232.1,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLE PERCTNUS 21G","code_information":[{"code":"18527","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":5.6,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE ENDO VERSA","code_information":[{"code":"18528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility"}]},{"description":"KIT MICRO INTRODUCER","code_information":[{"code":"18529","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.85,"discounted_cash":30.43,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDING VARIOUS","code_information":[{"code":"18530","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":346.65,"discounted_cash":173.32,"setting":"both","billing_class":"facility"}]},{"description":"KIT COPILOT","code_information":[{"code":"18531","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.3,"discounted_cash":55.15,"setting":"both","billing_class":"facility"}]},{"description":"SYRNGE CRNARY CNTRL","code_information":[{"code":"18532","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":6.5,"setting":"both","billing_class":"facility"}]},{"description":"CATH VASCULAR 0.014","code_information":[{"code":"18533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1088.45,"discounted_cash":544.23,"setting":"both","billing_class":"facility"}]},{"description":"CATH GUIDLNER 3.5 6F","code_information":[{"code":"18534","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":962.3,"discounted_cash":481.15,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM AMICA 14GA 15","code_information":[{"code":"18535","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":4536.35,"discounted_cash":2268.18,"setting":"both","billing_class":"facility"}]},{"description":"NDLE INTRO AMICA 14G","code_information":[{"code":"18536","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":218.15,"discounted_cash":109.08,"setting":"both","billing_class":"facility"}]},{"description":"COMPRSSON BAND 24 29","code_information":[{"code":"18537","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.95,"discounted_cash":51.98,"setting":"both","billing_class":"facility"}]},{"description":"EXT FIELDER GUIDEWIR","code_information":[{"code":"18538","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":200.55,"discounted_cash":100.28,"setting":"both","billing_class":"facility"}]},{"description":"CATH TURNPIKE 135CM","code_information":[{"code":"18539","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1270.5,"discounted_cash":635.25,"setting":"both","billing_class":"facility"}]},{"description":"NEELDE SMART BARE","code_information":[{"code":"18540","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":331.8,"discounted_cash":165.9,"setting":"both","billing_class":"facility"}]},{"description":"FIBER LSR NEVERTOUCH","code_information":[{"code":"18541","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1888","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1119.95,"discounted_cash":559.98,"setting":"both","billing_class":"facility"}]},{"description":"BLN CATHS VARIOUS SZ","code_information":[{"code":"18542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":413.6,"discounted_cash":206.8,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM CORONARY STNT","code_information":[{"code":"18543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":3181.55,"discounted_cash":1590.78,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH PINNACLE VARI","code_information":[{"code":"18544","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":376.3,"discounted_cash":188.15,"setting":"both","billing_class":"facility"}]},{"description":"STENT COPE 8.5FRX22","code_information":[{"code":"18545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":198.5,"setting":"both","billing_class":"facility"}]},{"description":"CATH ANGIO OMNI 5FRX","code_information":[{"code":"18546","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2625","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":572.65,"discounted_cash":286.32,"setting":"both","billing_class":"facility"}]},{"description":"MYOCRD STRAIN SPCKL","code_information":[{"code":"18547","type":"CDM"},{"code":"480","type":"RC"},{"code":"93356","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":606.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility"}]},{"description":"STENT VASCU VARIOUS","code_information":[{"code":"18548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":5863.95,"discounted_cash":2931.97,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN ALLPURPOSE","code_information":[{"code":"18549","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":527.5,"discounted_cash":263.75,"setting":"both","billing_class":"facility"}]},{"description":"SHEATH COOK VARIOUS","code_information":[{"code":"18550","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":285.4,"discounted_cash":142.7,"setting":"both","billing_class":"facility"}]},{"description":"DEVICE PRESSURE ASST","code_information":[{"code":"18551","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":168.7,"discounted_cash":84.35,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA CATH LAB CO2","code_information":[{"code":"18552","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.3,"discounted_cash":20.65,"setting":"both","billing_class":"facility"}]},{"description":"IMPELLA DEVICE VNTRC","code_information":[{"code":"18553","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":39884.05,"discounted_cash":19942.03,"setting":"both","billing_class":"facility"}]},{"description":"FILTER IVC SENTRY","code_information":[{"code":"18554","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":3255.95,"discounted_cash":1627.97,"setting":"both","billing_class":"facility"}]},{"description":"CLOSURE ZEPHYR VASC","code_information":[{"code":"18555","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1880","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":36.5,"setting":"both","billing_class":"facility"}]},{"description":"EVNT RCRDR CARDC G48","code_information":[{"code":"18556","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1764","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":11047.9,"discounted_cash":5523.95,"setting":"both","billing_class":"facility"}]},{"description":"BALN WOLVERINE VARIO","code_information":[{"code":"18557","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1612.0,"discounted_cash":806.0,"setting":"both","billing_class":"facility"}]},{"description":"KITCATH HEMO 19CM 23","code_information":[{"code":"18558","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.3,"discounted_cash":453.65,"setting":"both","billing_class":"facility"}]},{"description":"KIT PLEURX PERI/PLEU","code_information":[{"code":"18559","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1613.15,"discounted_cash":806.58,"setting":"both","billing_class":"facility"}]},{"description":"GUIDEWIRE OMINWIRE","code_information":[{"code":"18560","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1954.45,"discounted_cash":977.23,"setting":"both","billing_class":"facility"}]},{"description":"KIT CORE BIOPSY","code_information":[{"code":"18561","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":208.95,"discounted_cash":104.47,"setting":"both","billing_class":"facility"}]},{"description":"KIT CAT RX INDIGO SY","code_information":[{"code":"18562","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":5181.45,"discounted_cash":2590.72,"setting":"both","billing_class":"facility"}]},{"description":"CATH SHOCKWAVE IVLC2","code_information":[{"code":"18563","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1761","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":8997.75,"discounted_cash":4498.88,"setting":"both","billing_class":"facility"}]},{"description":"SLEEVE IVL CABLE","code_information":[{"code":"18564","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1761","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.9,"discounted_cash":11.45,"setting":"both","billing_class":"facility"}]},{"description":"STENT ONXY FRONTIER","code_information":[{"code":"18565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1457.15,"discounted_cash":728.58,"setting":"both","billing_class":"facility"}]},{"description":"STENT SYNERGY XD 48M","code_information":[{"code":"18566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":2238.05,"discounted_cash":1119.03,"setting":"both","billing_class":"facility"}]},{"description":"CATH HEMO 24CMX15.5F","code_information":[{"code":"18567","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":331.8,"discounted_cash":165.9,"setting":"both","billing_class":"facility"}]},{"description":"CATH IBA VARIOUS SIZ","code_information":[{"code":"18568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.95,"discounted_cash":671.48,"setting":"both","billing_class":"facility"}]},{"description":"STENT SYNERGY XD VAR","code_information":[{"code":"18569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.95,"discounted_cash":671.48,"setting":"both","billing_class":"facility"}]},{"description":"KIT HEMO LNGTRM CATH","code_information":[{"code":"18570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":374.3,"discounted_cash":187.15,"setting":"both","billing_class":"facility"}]},{"description":"SET GASTRO ANCHOR","code_information":[{"code":"18571","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":274.85,"discounted_cash":137.43,"setting":"both","billing_class":"facility"}]},{"description":"EKG TRACING","code_information":[{"code":"18572","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":269.28,"discounted_cash":134.64,"setting":"both","billing_class":"facility"}]},{"description":"EKG INTERP/RPT","code_information":[{"code":"18576","type":"CDM"},{"code":"985","type":"RC"},{"code":"93010","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.16,"discounted_cash":10.58,"setting":"both","billing_class":"facility"}]},{"description":"STRESS TST PHY SUPRV","code_information":[{"code":"18580","type":"CDM"},{"code":"985","type":"RC"},{"code":"93016","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.29,"discounted_cash":27.14,"setting":"both","billing_class":"facility"}]},{"description":"STRESS TEST TRACING","code_information":[{"code":"18581","type":"CDM"},{"code":"482","type":"RC"},{"code":"93017","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":1279.86,"discounted_cash":639.93,"setting":"both","billing_class":"facility"}]},{"description":"STRESS TST INT/RPT","code_information":[{"code":"18582","type":"CDM"},{"code":"985","type":"RC"},{"code":"93018","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.1,"discounted_cash":18.55,"setting":"both","billing_class":"facility"}]},{"description":"CARDIO STRESS TEST","code_information":[{"code":"18583","type":"CDM"},{"code":"482","type":"RC"},{"code":"93015","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":1325.16,"discounted_cash":662.58,"setting":"both","billing_class":"facility"}]},{"description":"EKG 48HR W/VIS SCAN","code_information":[{"code":"18586","type":"CDM"},{"code":"731","type":"RC"},{"code":"93224","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":1445.5,"discounted_cash":722.75,"setting":"both","billing_class":"facility"}]},{"description":"HOLTER 48HR RECORD","code_information":[{"code":"18587","type":"CDM"},{"code":"731","type":"RC"},{"code":"93225","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":755.22,"discounted_cash":377.61,"setting":"both","billing_class":"facility"}]},{"description":"ECHO COLOR DOP PF","code_information":[{"code":"18588","type":"CDM"},{"code":"985","type":"RC"},{"code":"93325","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.88,"discounted_cash":4.44,"setting":"both","billing_class":"facility"}]},{"description":"HOLTER 48HR SCAN/RPT","code_information":[{"code":"18589","type":"CDM"},{"code":"731","type":"RC"},{"code":"93226","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":662.48,"discounted_cash":331.24,"setting":"both","billing_class":"facility"}]},{"description":"48HR HLTER INT/RPT","code_information":[{"code":"18591","type":"CDM"},{"code":"985","type":"RC"},{"code":"93227","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":67.51,"discounted_cash":33.76,"setting":"both","billing_class":"facility"}]},{"description":"TTE W/DOPPLER COMP","code_information":[{"code":"18592","type":"CDM"},{"code":"483","type":"RC"},{"code":"93306","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":2582.3,"discounted_cash":1291.15,"setting":"both","billing_class":"facility"}]},{"description":"TTE W/DOPPLER CMP PF","code_information":[{"code":"18595","type":"CDM"},{"code":"985","type":"RC"},{"code":"93306","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.9,"discounted_cash":507.45,"setting":"both","billing_class":"facility"}]},{"description":"ECHO D&M LTD","code_information":[{"code":"18596","type":"CDM"},{"code":"483","type":"RC"},{"code":"93308","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":897.92,"discounted_cash":448.96,"setting":"both","billing_class":"facility"}]},{"description":"ECHO D&M LIMITED PF","code_information":[{"code":"18597","type":"CDM"},{"code":"985","type":"RC"},{"code":"93308","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.41,"discounted_cash":202.71,"setting":"both","billing_class":"facility"}]},{"description":"ECHO TTHRC CONGNTAL","code_information":[{"code":"18598","type":"CDM"},{"code":"483","type":"RC"},{"code":"93303","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":1567.34,"discounted_cash":783.67,"setting":"both","billing_class":"facility"}]},{"description":"TRANSESOPH ECHO","code_information":[{"code":"18599","type":"CDM"},{"code":"483","type":"RC"},{"code":"93312","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":2500.11,"discounted_cash":1250.06,"setting":"both","billing_class":"facility"}]},{"description":"ECHO COLOR DOP","code_information":[{"code":"18603","type":"CDM"},{"code":"483","type":"RC"},{"code":"93325","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":920.85,"discounted_cash":460.43,"setting":"both","billing_class":"facility"}]},{"description":"STRESS ECHO","code_information":[{"code":"18604","type":"CDM"},{"code":"483","type":"RC"},{"code":"93350","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":1987.22,"discounted_cash":993.61,"setting":"both","billing_class":"facility"}]},{"description":"STRESS ECHO INT/RPT","code_information":[{"code":"18605","type":"CDM"},{"code":"985","type":"RC"},{"code":"93350","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":1567.34,"discounted_cash":783.67,"setting":"both","billing_class":"facility"}]},{"description":"ECHO DOP COMP","code_information":[{"code":"18609","type":"CDM"},{"code":"483","type":"RC"},{"code":"93320","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":1073.22,"discounted_cash":536.61,"setting":"both","billing_class":"facility"}]},{"description":"ECHO DOPPLER CMP PF","code_information":[{"code":"18610","type":"CDM"},{"code":"985","type":"RC"},{"code":"93320","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.84,"discounted_cash":32.92,"setting":"both","billing_class":"facility"}]},{"description":"INJ IV BUBBLE STUDY","code_information":[{"code":"18612","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":133.3,"discounted_cash":66.65,"setting":"both","billing_class":"facility"}]},{"description":"PERFLUTREN LIPID 1ML","code_information":[{"code":"18618","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"692","type":"LOCAL"}],"standard_charges":[{"gross_charge":392.95,"discounted_cash":196.47,"setting":"both","billing_class":"facility"}]},{"description":"EEG AWAKE & ASLEEP","code_information":[{"code":"18625","type":"CDM"},{"code":"740","type":"RC"},{"code":"95819","type":"CPT"},{"code":"735","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.51,"discounted_cash":440.75,"setting":"both","billing_class":"facility"}]},{"description":"EEG EXTENDED UP TO 1","code_information":[{"code":"18629","type":"CDM"},{"code":"740","type":"RC"},{"code":"95812","type":"CPT"},{"code":"735","type":"LOCAL"}],"standard_charges":[{"gross_charge":922.11,"discounted_cash":461.06,"setting":"both","billing_class":"facility"}]},{"description":"EEG EXTENDED >1HR","code_information":[{"code":"18633","type":"CDM"},{"code":"740","type":"RC"},{"code":"95813","type":"CPT"},{"code":"735","type":"LOCAL"}],"standard_charges":[{"gross_charge":1167.79,"discounted_cash":583.89,"setting":"both","billing_class":"facility"}]},{"description":"OXYGEN PER DAY","code_information":[{"code":"18657","type":"CDM"},{"code":"270","type":"RC"},{"code":"95933","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":849.25,"discounted_cash":424.63,"setting":"both","billing_class":"facility"}]},{"description":"CPR","code_information":[{"code":"18675","type":"CDM"},{"code":"480","type":"RC"},{"code":"92950","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.51,"discounted_cash":440.75,"setting":"both","billing_class":"facility"}]},{"description":"PFT SPIROMETRY","code_information":[{"code":"18676","type":"CDM"},{"code":"460","type":"RC"},{"code":"94010","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.25,"discounted_cash":202.63,"setting":"both","billing_class":"facility"}]},{"description":"PFT SPIROMETRY B&A","code_information":[{"code":"18677","type":"CDM"},{"code":"460","type":"RC"},{"code":"94060","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.6,"discounted_cash":348.3,"setting":"both","billing_class":"facility"}]},{"description":"VITAL CAP TTL SEP PR","code_information":[{"code":"18679","type":"CDM"},{"code":"460","type":"RC"},{"code":"94150","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"GAS DILTN/WASH OUT","code_information":[{"code":"18681","type":"CDM"},{"code":"460","type":"RC"},{"code":"94727","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":238.1,"discounted_cash":119.05,"setting":"both","billing_class":"facility"}]},{"description":"PLESMOGRAPHY","code_information":[{"code":"18683","type":"CDM"},{"code":"460","type":"RC"},{"code":"94726","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":639.59,"discounted_cash":319.8,"setting":"both","billing_class":"facility"}]},{"description":"PULM STRESS TEST SIM","code_information":[{"code":"18689","type":"CDM"},{"code":"460","type":"RC"},{"code":"94618","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":343.23,"discounted_cash":171.62,"setting":"both","billing_class":"facility"}]},{"description":"VENT MGMT INIT/DAY","code_information":[{"code":"18697","type":"CDM"},{"code":"410","type":"RC"},{"code":"94002","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":1028.23,"discounted_cash":514.12,"setting":"both","billing_class":"facility"}]},{"description":"VENT MGMT SUBSEQ/DAY","code_information":[{"code":"18698","type":"CDM"},{"code":"410","type":"RC"},{"code":"94003","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":1028.23,"discounted_cash":514.12,"setting":"both","billing_class":"facility"}]},{"description":"CPAP EA ADD DAY MGMT","code_information":[{"code":"18700","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":423.38,"discounted_cash":211.69,"setting":"both","billing_class":"facility"}]},{"description":"CPAP INST & MGMT","code_information":[{"code":"18701","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":423.38,"discounted_cash":211.69,"setting":"both","billing_class":"facility"}]},{"description":"BIPAP INST & MGMT","code_information":[{"code":"18702","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":514.09,"discounted_cash":257.05,"setting":"both","billing_class":"facility"}]},{"description":"BIPAP EA ADD DAY MGM","code_information":[{"code":"18703","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":423.38,"discounted_cash":211.69,"setting":"both","billing_class":"facility"}]},{"description":"AEROSOL CONTINUOUS","code_information":[{"code":"18706","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":360.47,"discounted_cash":180.24,"setting":"both","billing_class":"facility"}]},{"description":"CPT INITIAL","code_information":[{"code":"18711","type":"CDM"},{"code":"410","type":"RC"},{"code":"94667","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":163.33,"discounted_cash":81.67,"setting":"both","billing_class":"facility"}]},{"description":"CPT SUBSEQUENT","code_information":[{"code":"18712","type":"CDM"},{"code":"410","type":"RC"},{"code":"94668","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.18,"discounted_cash":38.09,"setting":"both","billing_class":"facility"}]},{"description":"DIFFUSING CAPACITY","code_information":[{"code":"18716","type":"CDM"},{"code":"460","type":"RC"},{"code":"94729","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":253.31,"discounted_cash":126.66,"setting":"both","billing_class":"facility"}]},{"description":"PULSE OX SINGLE DET","code_information":[{"code":"18719","type":"CDM"},{"code":"460","type":"RC"},{"code":"94760","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.17,"discounted_cash":17.09,"setting":"both","billing_class":"facility"}]},{"description":"PULSE OX MULTIPLE","code_information":[{"code":"18720","type":"CDM"},{"code":"460","type":"RC"},{"code":"94761","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":122.84,"discounted_cash":61.42,"setting":"both","billing_class":"facility"}]},{"description":"PULSE OX CONT ON","code_information":[{"code":"18721","type":"CDM"},{"code":"460","type":"RC"},{"code":"94762","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":226.71,"discounted_cash":113.36,"setting":"both","billing_class":"facility"}]},{"description":"HHN INITIAL","code_information":[{"code":"18728","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":360.68,"discounted_cash":180.34,"setting":"both","billing_class":"facility"}]},{"description":"HHN TX SUBS","code_information":[{"code":"18729","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":361.73,"discounted_cash":180.87,"setting":"both","billing_class":"facility"}]},{"description":"MDI TX INITIAL","code_information":[{"code":"18730","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":361.73,"discounted_cash":180.87,"setting":"both","billing_class":"facility"}]},{"description":"MDI TX SUBS","code_information":[{"code":"18731","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":360.47,"discounted_cash":180.24,"setting":"both","billing_class":"facility"}]},{"description":"ARTERIAL PUNCTURE","code_information":[{"code":"18733","type":"CDM"},{"code":"410","type":"RC"},{"code":"36600","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.11,"discounted_cash":118.56,"setting":"both","billing_class":"facility"}]},{"description":"INTUBATION EMERGENCY","code_information":[{"code":"18734","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":396.42,"discounted_cash":198.21,"setting":"both","billing_class":"facility"}]},{"description":"NB RESUSCITATION","code_information":[{"code":"18763","type":"CDM"},{"code":"410","type":"RC"},{"code":"99465","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.15,"discounted_cash":519.58,"setting":"both","billing_class":"facility"}]},{"description":"NASOTRACHEAL SUCTION","code_information":[{"code":"18764","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":347.3,"discounted_cash":173.65,"setting":"both","billing_class":"facility"}]},{"description":"ATTENDANCE AT DELVRY","code_information":[{"code":"18765","type":"CDM"},{"code":"410","type":"RC"},{"code":"99464","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.55,"discounted_cash":63.27,"setting":"both","billing_class":"facility"}]},{"description":"CBT 1ST HOUR","code_information":[{"code":"18766","type":"CDM"},{"code":"410","type":"RC"},{"code":"94644","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":362.93,"discounted_cash":181.47,"setting":"both","billing_class":"facility"}]},{"description":"CBT EACH ADDL HOUR","code_information":[{"code":"18767","type":"CDM"},{"code":"410","type":"RC"},{"code":"94645","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.96,"discounted_cash":60.48,"setting":"both","billing_class":"facility"}]},{"description":"DEMO/EVAL PT USE/INH","code_information":[{"code":"18768","type":"CDM"},{"code":"410","type":"RC"},{"code":"94664","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":615.4,"discounted_cash":307.7,"setting":"both","billing_class":"facility"}]},{"description":"DX BRONCHOSC/LAVAGE","code_information":[{"code":"18769","type":"CDM"},{"code":"750","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":3618.63,"discounted_cash":1809.32,"setting":"both","billing_class":"facility"}]},{"description":"DX BRONCHOSCOP/BRUSH","code_information":[{"code":"18770","type":"CDM"},{"code":"750","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":3618.63,"discounted_cash":1809.32,"setting":"both","billing_class":"facility"}]},{"description":"DX BRONCHOSCOPE/WASH","code_information":[{"code":"18771","type":"CDM"},{"code":"750","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":3618.63,"discounted_cash":1809.32,"setting":"both","billing_class":"facility"}]},{"description":"SPUTUM COLLECT ONLY","code_information":[{"code":"18772","type":"CDM"},{"code":"412","type":"RC"},{"code":"89220","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":412.98,"discounted_cash":206.49,"setting":"both","billing_class":"facility"}]},{"description":"RT MCOT","code_information":[{"code":"18773","type":"CDM"},{"code":"731","type":"RC"},{"code":"93270","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":164.64,"discounted_cash":82.32,"setting":"both","billing_class":"facility"}]},{"description":"VAPOTHERM","code_information":[{"code":"18774","type":"CDM"},{"code":"410","type":"RC"},{"code":"94799","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":531.64,"discounted_cash":265.82,"setting":"both","billing_class":"facility"}]},{"description":"BEHAV SMOKING 3-10 M","code_information":[{"code":"18775","type":"CDM"},{"code":"942","type":"RC"},{"code":"99406","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":92.17,"discounted_cash":46.09,"setting":"both","billing_class":"facility"}]},{"description":"BEHAV SMOKING >10M","code_information":[{"code":"18776","type":"CDM"},{"code":"942","type":"RC"},{"code":"99407","type":"CPT"},{"code":"660","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.15,"discounted_cash":62.08,"setting":"both","billing_class":"facility"}]},{"description":"PATHOGEN TST PLATLET","code_information":[{"code":"18777","type":"CDM"},{"code":"319","type":"RC"},{"code":"P9100","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":213.4,"discounted_cash":106.7,"setting":"both","billing_class":"facility"}]},{"description":"PLATELET LEUKO REDUC","code_information":[{"code":"18778","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9031","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":523.39,"discounted_cash":261.69,"setting":"both","billing_class":"facility"}]},{"description":"PLATELET PHERES LR","code_information":[{"code":"18779","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":1779.16,"discounted_cash":889.58,"setting":"both","billing_class":"facility"}]},{"description":"PRBC","code_information":[{"code":"18780","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9021","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.78,"discounted_cash":227.89,"setting":"both","billing_class":"facility"}]},{"description":"PRBC IRRAD","code_information":[{"code":"18782","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9038","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":448.36,"discounted_cash":224.18,"setting":"both","billing_class":"facility"}]},{"description":"PRBC WBC-RD IRRAD","code_information":[{"code":"18784","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9040","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":562.31,"discounted_cash":281.15,"setting":"both","billing_class":"facility"}]},{"description":"PRBC WBC-RD","code_information":[{"code":"18786","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":520.67,"discounted_cash":260.33,"setting":"both","billing_class":"facility"}]},{"description":"FFP SINGLE DONOR","code_information":[{"code":"18792","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9017","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":220.39,"discounted_cash":110.19,"setting":"both","billing_class":"facility"}]},{"description":"PLT CONC/UNIT","code_information":[{"code":"18798","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9019","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":206.44,"discounted_cash":103.22,"setting":"both","billing_class":"facility"}]},{"description":"PLT IRRAD","code_information":[{"code":"18800","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9032","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.99,"discounted_cash":152.0,"setting":"both","billing_class":"facility"}]},{"description":"PLT PHER","code_information":[{"code":"18801","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9034","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":1414.72,"discounted_cash":707.36,"setting":"both","billing_class":"facility"}]},{"description":"PLT WBC-RD IRR A/PH","code_information":[{"code":"18806","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9037","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":1519.9,"discounted_cash":759.95,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD, L/R, CMV-NEG","code_information":[{"code":"18808","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9051","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":765.78,"discounted_cash":382.89,"setting":"both","billing_class":"facility"}]},{"description":"RBC L/R CMV-NEG IRRA","code_information":[{"code":"18809","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9058","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":904.6,"discounted_cash":452.3,"setting":"both","billing_class":"facility"}]},{"description":"POOL PR PLASMA","code_information":[{"code":"18810","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9070","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":169.45,"discounted_cash":84.72,"setting":"both","billing_class":"facility"}]},{"description":"SINGLE PR PLASMA","code_information":[{"code":"18811","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9071","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":359.48,"discounted_cash":179.74,"setting":"both","billing_class":"facility"}]},{"description":"PRT PLATELETS PHRSS","code_information":[{"code":"18812","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9073","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.81,"discounted_cash":679.4,"setting":"both","billing_class":"facility"}]},{"description":"PLATELET PHERESIS IR","code_information":[{"code":"18813","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9036","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":2059.7,"discounted_cash":1029.85,"setting":"both","billing_class":"facility"}]},{"description":"CRYOPRECIPITATE","code_information":[{"code":"18814","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9012","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":329.28,"discounted_cash":164.64,"setting":"both","billing_class":"facility"}]},{"description":"RHOGAM HMN IM INJECT","code_information":[{"code":"18820","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2790","type":"HCPCS"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":260.71,"discounted_cash":130.35,"setting":"both","billing_class":"facility"}]},{"description":"FFP THAWING/UNIT","code_information":[{"code":"18827","type":"CDM"},{"code":"300","type":"RC"},{"code":"86927","type":"CPT"},{"code":"720","type":"LOCAL"}],"standard_charges":[{"gross_charge":506.6,"discounted_cash":253.3,"setting":"both","billing_class":"facility"}]},{"description":"THER IVNTJ 1ST 15 MI","code_information":[{"code":"18829","type":"CDM"},{"code":"440","type":"RC"},{"code":"97129","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.25,"discounted_cash":51.13,"setting":"both","billing_class":"facility"}]},{"description":"THER IVNTJ ADDL 15","code_information":[{"code":"18830","type":"CDM"},{"code":"440","type":"RC"},{"code":"97130","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":99.07,"discounted_cash":49.53,"setting":"both","billing_class":"facility"}]},{"description":"ST EVAL FLUENCY","code_information":[{"code":"18836","type":"CDM"},{"code":"444","type":"RC"},{"code":"92521","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":230.53,"discounted_cash":115.27,"setting":"both","billing_class":"facility"}]},{"description":"ST EVAL SOUND PROD","code_information":[{"code":"18837","type":"CDM"},{"code":"444","type":"RC"},{"code":"92522","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":230.53,"discounted_cash":115.27,"setting":"both","billing_class":"facility"}]},{"description":"ST EV SOUND LANG CMP","code_information":[{"code":"18838","type":"CDM"},{"code":"444","type":"RC"},{"code":"92523","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.96,"discounted_cash":189.98,"setting":"both","billing_class":"facility"}]},{"description":"ST BEHVR QL ANALYS","code_information":[{"code":"18839","type":"CDM"},{"code":"444","type":"RC"},{"code":"92524","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":77.25,"setting":"both","billing_class":"facility"}]},{"description":"ST IND TX LTD","code_information":[{"code":"18840","type":"CDM"},{"code":"441","type":"RC"},{"code":"92507","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":215.32,"discounted_cash":107.66,"setting":"both","billing_class":"facility"}]},{"description":"ST IND TX INT","code_information":[{"code":"18841","type":"CDM"},{"code":"440","type":"RC"},{"code":"92507","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":257.07,"discounted_cash":128.53,"setting":"both","billing_class":"facility"}]},{"description":"ST IND TX EXT","code_information":[{"code":"18842","type":"CDM"},{"code":"440","type":"RC"},{"code":"92507","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":257.07,"discounted_cash":128.53,"setting":"both","billing_class":"facility"}]},{"description":"DYSPHAGIA EVAL LTD","code_information":[{"code":"18848","type":"CDM"},{"code":"444","type":"RC"},{"code":"92610","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":77.25,"setting":"both","billing_class":"facility"}]},{"description":"DYSPHAGIA TX LTD","code_information":[{"code":"18852","type":"CDM"},{"code":"440","type":"RC"},{"code":"92526","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.4,"discounted_cash":55.7,"setting":"both","billing_class":"facility"}]},{"description":"DYSPHAGIA TX INT","code_information":[{"code":"18853","type":"CDM"},{"code":"440","type":"RC"},{"code":"92526","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.4,"discounted_cash":55.7,"setting":"both","billing_class":"facility"}]},{"description":"DYSPHAGIA TX EXT","code_information":[{"code":"18854","type":"CDM"},{"code":"441","type":"RC"},{"code":"92526","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.4,"discounted_cash":55.7,"setting":"both","billing_class":"facility"}]},{"description":"DYSPHAGIA TX","code_information":[{"code":"18855","type":"CDM"},{"code":"440","type":"RC"},{"code":"92526","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.4,"discounted_cash":55.7,"setting":"both","billing_class":"facility"}]},{"description":"SENSORY TRAINING 15\"","code_information":[{"code":"18858","type":"CDM"},{"code":"440","type":"RC"},{"code":"97533","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.23,"discounted_cash":38.62,"setting":"both","billing_class":"facility"}]},{"description":"AUD REHAB POSTLINGHL","code_information":[{"code":"18861","type":"CDM"},{"code":"440","type":"RC"},{"code":"92633","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":463.51,"discounted_cash":231.75,"setting":"both","billing_class":"facility"}]},{"description":"APHASIA ASSESSMENT","code_information":[{"code":"18863","type":"CDM"},{"code":"440","type":"RC"},{"code":"96105","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":278.65,"discounted_cash":139.32,"setting":"both","billing_class":"facility"}]},{"description":"EVAL SP GEN DEV 1STH","code_information":[{"code":"18864","type":"CDM"},{"code":"444","type":"RC"},{"code":"92607","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":187.47,"discounted_cash":93.73,"setting":"both","billing_class":"facility"}]},{"description":"TRAIN FOR SP GEN DEV","code_information":[{"code":"18865","type":"CDM"},{"code":"440","type":"RC"},{"code":"92609","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":233.04,"discounted_cash":116.52,"setting":"both","billing_class":"facility"}]},{"description":"EVAL NONSP GEN DEV","code_information":[{"code":"18869","type":"CDM"},{"code":"444","type":"RC"},{"code":"92605","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":165.89,"discounted_cash":82.94,"setting":"both","billing_class":"facility"}]},{"description":"TX SVC NONSP GEN DEV","code_information":[{"code":"18870","type":"CDM"},{"code":"440","type":"RC"},{"code":"92606","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":233.04,"discounted_cash":116.52,"setting":"both","billing_class":"facility"}]},{"description":"NEUROMUSC RE-ED/15\"","code_information":[{"code":"18876","type":"CDM"},{"code":"440","type":"RC"},{"code":"97112","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":125.4,"discounted_cash":62.7,"setting":"both","billing_class":"facility"}]},{"description":"VIDEO SWALLOW EVAL","code_information":[{"code":"18878","type":"CDM"},{"code":"444","type":"RC"},{"code":"92611","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":420.46,"discounted_cash":210.23,"setting":"both","billing_class":"facility"}]},{"description":"ST EXERCISE TX 15\"","code_information":[{"code":"18880","type":"CDM"},{"code":"440","type":"RC"},{"code":"97110","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.84,"discounted_cash":89.92,"setting":"both","billing_class":"facility"}]},{"description":"DEVELOP TST EXT 1 H","code_information":[{"code":"18882","type":"CDM"},{"code":"440","type":"RC"},{"code":"96112","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":338.16,"discounted_cash":169.08,"setting":"both","billing_class":"facility"}]},{"description":"DEVELOP TST ADD 30M","code_information":[{"code":"18883","type":"CDM"},{"code":"440","type":"RC"},{"code":"96113","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.94,"discounted_cash":47.47,"setting":"both","billing_class":"facility"}]},{"description":"PURE TONE AUDIOMETRY","code_information":[{"code":"18886","type":"CDM"},{"code":"471","type":"RC"},{"code":"92552","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":284.97,"discounted_cash":142.49,"setting":"both","billing_class":"facility"}]},{"description":"GROUP SPEECH THERAPY","code_information":[{"code":"18913","type":"CDM"},{"code":"443","type":"RC"},{"code":"92508","type":"CPT"},{"code":"646","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.98,"discounted_cash":51.99,"setting":"both","billing_class":"facility"}]},{"description":"APP SPL LONG ARM","code_information":[{"code":"18925","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":333.3,"discounted_cash":166.65,"setting":"both","billing_class":"facility"}]},{"description":"APP SPL SHRT ARM ST","code_information":[{"code":"18926","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":378.15,"discounted_cash":189.07,"setting":"both","billing_class":"facility"}]},{"description":"APP SPL SHRT ARM DYN","code_information":[{"code":"18927","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":339.35,"discounted_cash":169.68,"setting":"both","billing_class":"facility"}]},{"description":"TENS APPLICATION","code_information":[{"code":"18947","type":"CDM"},{"code":"420","type":"RC"},{"code":"G0283","type":"HCPCS"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.97,"discounted_cash":37.98,"setting":"both","billing_class":"facility"}]},{"description":"PT EVAL LTD","code_information":[{"code":"18962","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":409.12,"discounted_cash":204.56,"setting":"both","billing_class":"facility"}]},{"description":"PT EVAL INT","code_information":[{"code":"18963","type":"CDM"},{"code":"424","type":"RC"},{"code":"97162","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":485.09,"discounted_cash":242.54,"setting":"both","billing_class":"facility"}]},{"description":"PT EVAL EXT","code_information":[{"code":"18964","type":"CDM"},{"code":"424","type":"RC"},{"code":"97163","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":485.09,"discounted_cash":242.54,"setting":"both","billing_class":"facility"}]},{"description":"PT RE-EVAL","code_information":[{"code":"18967","type":"CDM"},{"code":"424","type":"RC"},{"code":"97164","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.11,"discounted_cash":43.05,"setting":"both","billing_class":"facility"}]},{"description":"MECH TRACTION/VISIT","code_information":[{"code":"18972","type":"CDM"},{"code":"420","type":"RC"},{"code":"97012","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.52,"discounted_cash":86.76,"setting":"both","billing_class":"facility"}]},{"description":"ELEC STIM UNAT VISIT","code_information":[{"code":"18973","type":"CDM"},{"code":"420","type":"RC"},{"code":"G0283","type":"HCPCS"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":139.3,"discounted_cash":69.65,"setting":"both","billing_class":"facility"}]},{"description":"WHIRLPOOL/ VISIT","code_information":[{"code":"18978","type":"CDM"},{"code":"420","type":"RC"},{"code":"97022","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":171.01,"discounted_cash":85.5,"setting":"both","billing_class":"facility"}]},{"description":"ELEC STIM MAN/15 MIN","code_information":[{"code":"18982","type":"CDM"},{"code":"420","type":"RC"},{"code":"97032","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":139.3,"discounted_cash":69.65,"setting":"both","billing_class":"facility"}]},{"description":"IONTOPHORESIS/15 MIN","code_information":[{"code":"18983","type":"CDM"},{"code":"420","type":"RC"},{"code":"97033","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":203.93,"discounted_cash":101.97,"setting":"both","billing_class":"facility"}]},{"description":"CNTRST BATH/15 MIN","code_information":[{"code":"18984","type":"CDM"},{"code":"420","type":"RC"},{"code":"97034","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.85,"discounted_cash":42.42,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND/15 MIN","code_information":[{"code":"18985","type":"CDM"},{"code":"420","type":"RC"},{"code":"97035","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":135.48,"discounted_cash":67.74,"setting":"both","billing_class":"facility"}]},{"description":"THER EXER/15 MIN","code_information":[{"code":"18987","type":"CDM"},{"code":"420","type":"RC"},{"code":"97110","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":215.32,"discounted_cash":107.66,"setting":"both","billing_class":"facility"}]},{"description":"PTA THER EXER/15 MIN","code_information":[{"code":"18988","type":"CDM"},{"code":"420","type":"RC"},{"code":"97110","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":215.32,"discounted_cash":107.66,"setting":"both","billing_class":"facility"}]},{"description":"PTA THERPACT/15 MIN","code_information":[{"code":"18991","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":79.79,"discounted_cash":39.9,"setting":"both","billing_class":"facility"}]},{"description":"PTA GAIT TRAINING 15","code_information":[{"code":"18992","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility"}]},{"description":"PTA NEURO RE-ED 15 M","code_information":[{"code":"18993","type":"CDM"},{"code":"420","type":"RC"},{"code":"97112","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":105.13,"discounted_cash":52.56,"setting":"both","billing_class":"facility"}]},{"description":"PTA MANUAL THER 15 M","code_information":[{"code":"18994","type":"CDM"},{"code":"420","type":"RC"},{"code":"97140","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":185.44,"discounted_cash":92.72,"setting":"both","billing_class":"facility"}]},{"description":"PTA AQUATIC THER 15","code_information":[{"code":"18995","type":"CDM"},{"code":"420","type":"RC"},{"code":"97113","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":201.37,"discounted_cash":100.69,"setting":"both","billing_class":"facility"}]},{"description":"PTA MECH TRACTION","code_information":[{"code":"18996","type":"CDM"},{"code":"420","type":"RC"},{"code":"97012","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.52,"discounted_cash":86.76,"setting":"both","billing_class":"facility"}]},{"description":"NEURO RE-ED/15 MIN","code_information":[{"code":"18997","type":"CDM"},{"code":"420","type":"RC"},{"code":"97112","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":105.13,"discounted_cash":52.56,"setting":"both","billing_class":"facility"}]},{"description":"PTA ULTRASOUND 15 MI","code_information":[{"code":"18998","type":"CDM"},{"code":"420","type":"RC"},{"code":"97035","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":135.48,"discounted_cash":67.74,"setting":"both","billing_class":"facility"}]},{"description":"PTA ELEC STIM UNAT V","code_information":[{"code":"18999","type":"CDM"},{"code":"420","type":"RC"},{"code":"G0283","type":"HCPCS"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":139.3,"discounted_cash":69.65,"setting":"both","billing_class":"facility"}]},{"description":"NEG PRES WND TX >50","code_information":[{"code":"19","type":"CDM"},{"code":"761","type":"RC"},{"code":"97606","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.4,"discounted_cash":487.7,"setting":"both","billing_class":"facility"}]},{"description":"PTA ELEC STIM MAN 15","code_information":[{"code":"19000","type":"CDM"},{"code":"420","type":"RC"},{"code":"97032","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":139.3,"discounted_cash":69.65,"setting":"both","billing_class":"facility"}]},{"description":"PTA IONTOPHORESIS 15","code_information":[{"code":"19001","type":"CDM"},{"code":"420","type":"RC"},{"code":"97033","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":203.93,"discounted_cash":101.97,"setting":"both","billing_class":"facility"}]},{"description":"PTA OTHRO MGMT TRN 1","code_information":[{"code":"19002","type":"CDM"},{"code":"420","type":"RC"},{"code":"97760","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":67.14,"discounted_cash":33.57,"setting":"both","billing_class":"facility"}]},{"description":"PTA PROS/ORTHO CKOUT","code_information":[{"code":"19003","type":"CDM"},{"code":"420","type":"RC"},{"code":"97763","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":67.14,"discounted_cash":33.57,"setting":"both","billing_class":"facility"}]},{"description":"PTA PROSTHETIC TRAIN","code_information":[{"code":"19004","type":"CDM"},{"code":"420","type":"RC"},{"code":"97761","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":79.79,"discounted_cash":39.9,"setting":"both","billing_class":"facility"}]},{"description":"TRADITNAL 4 HOUR FCE","code_information":[{"code":"19005","type":"CDM"},{"code":"420","type":"RC"},{"code":"97750","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":759.98,"discounted_cash":379.99,"setting":"both","billing_class":"facility"}]},{"description":"TRAD 4HR FCE NO SHOW","code_information":[{"code":"19006","type":"CDM"},{"code":"949","type":"RC"},{"code":"97750","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":254.5,"discounted_cash":127.25,"setting":"both","billing_class":"facility"}]},{"description":"AQUATIC THER/15 MIN","code_information":[{"code":"19007","type":"CDM"},{"code":"420","type":"RC"},{"code":"97113","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":201.37,"discounted_cash":100.69,"setting":"both","billing_class":"facility"}]},{"description":"SHORT 2 HOUR FCE","code_information":[{"code":"19008","type":"CDM"},{"code":"420","type":"RC"},{"code":"97750","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":278.65,"discounted_cash":139.32,"setting":"both","billing_class":"facility"}]},{"description":"SHORT 2HR FCE NOSHOW","code_information":[{"code":"19009","type":"CDM"},{"code":"949","type":"RC"},{"code":"97750","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":133.3,"discounted_cash":66.65,"setting":"both","billing_class":"facility"}]},{"description":"WORK PROFILE TEST","code_information":[{"code":"19010","type":"CDM"},{"code":"420","type":"RC"},{"code":"97750","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":139.3,"discounted_cash":69.65,"setting":"both","billing_class":"facility"}]},{"description":"WORK PROFILE NOSHOW","code_information":[{"code":"19011","type":"CDM"},{"code":"949","type":"RC"},{"code":"97750","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.7,"discounted_cash":36.35,"setting":"both","billing_class":"facility"}]},{"description":"GAIT TRAINING/15 MIN","code_information":[{"code":"19012","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility"}]},{"description":"MASSAGE/15 MIN","code_information":[{"code":"19013","type":"CDM"},{"code":"420","type":"RC"},{"code":"97124","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.6,"discounted_cash":41.8,"setting":"both","modifier_code":["97","32"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 97: Rehabilitative Services | Modifier 32: Mandated Services"}]},{"description":"MANUAL THER/15 MIN","code_information":[{"code":"19014","type":"CDM"},{"code":"420","type":"RC"},{"code":"97140","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":185.44,"discounted_cash":92.72,"setting":"both","billing_class":"facility"}]},{"description":"GROUP THERAPY","code_information":[{"code":"19015","type":"CDM"},{"code":"423","type":"RC"},{"code":"97150","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.64,"discounted_cash":53.82,"setting":"both","billing_class":"facility"}]},{"description":"ORTHO MGMT/TRN 15MIN","code_information":[{"code":"19016","type":"CDM"},{"code":"420","type":"RC"},{"code":"97760","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":67.14,"discounted_cash":33.57,"setting":"both","billing_class":"facility"}]},{"description":"PROSTH TRAIN/15 MIN","code_information":[{"code":"19017","type":"CDM"},{"code":"420","type":"RC"},{"code":"97761","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":79.79,"discounted_cash":39.9,"setting":"both","billing_class":"facility"}]},{"description":"THERAPACT/15 MIN","code_information":[{"code":"19018","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":79.79,"discounted_cash":39.9,"setting":"both","billing_class":"facility"}]},{"description":"SENSORY TRN/15 MIN","code_information":[{"code":"19020","type":"CDM"},{"code":"420","type":"RC"},{"code":"97533","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.23,"discounted_cash":38.62,"setting":"both","billing_class":"facility"}]},{"description":"ADL/15 MIN","code_information":[{"code":"19021","type":"CDM"},{"code":"420","type":"RC"},{"code":"97535","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility"}]},{"description":"WHEELCHAIR TRN/15 MI","code_information":[{"code":"19023","type":"CDM"},{"code":"420","type":"RC"},{"code":"97542","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.21,"discounted_cash":36.1,"setting":"both","billing_class":"facility"}]},{"description":"WORK CONDITION/2HR","code_information":[{"code":"19024","type":"CDM"},{"code":"420","type":"RC"},{"code":"97545","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":241.87,"discounted_cash":120.94,"setting":"both","billing_class":"facility"}]},{"description":"PROS/ORTHO CKOUT 15M","code_information":[{"code":"19027","type":"CDM"},{"code":"420","type":"RC"},{"code":"97763","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":67.14,"discounted_cash":33.57,"setting":"both","billing_class":"facility"}]},{"description":"FCE 15MN","code_information":[{"code":"19029","type":"CDM"},{"code":"420","type":"RC"},{"code":"97750","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.11,"discounted_cash":43.05,"setting":"both","billing_class":"facility"}]},{"description":"FCE NOSHOW/LATE FEE","code_information":[{"code":"19030","type":"CDM"},{"code":"949","type":"RC"},{"code":"97750","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":60.6,"setting":"both","billing_class":"facility"}]},{"description":"SELF CARE 15 MIN","code_information":[{"code":"19062","type":"CDM"},{"code":"420","type":"RC"},{"code":"97535","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":45.56,"discounted_cash":22.78,"setting":"both","billing_class":"facility"}]},{"description":"CANALITH REPOSITION","code_information":[{"code":"19063","type":"CDM"},{"code":"420","type":"RC"},{"code":"95992","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":192.38,"discounted_cash":96.19,"setting":"both","billing_class":"facility"}]},{"description":"APP MULTLAY COMPRS L","code_information":[{"code":"19064","type":"CDM"},{"code":"761","type":"RC"},{"code":"29581","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":576.45,"discounted_cash":288.23,"setting":"both","billing_class":"facility"}]},{"description":"APP MULTLAY COMPRS A","code_information":[{"code":"19065","type":"CDM"},{"code":"761","type":"RC"},{"code":"29584","type":"CPT"},{"code":"640","type":"LOCAL"}],"standard_charges":[{"gross_charge":576.45,"discounted_cash":288.23,"setting":"both","billing_class":"facility"}]},{"description":"THYROID IMG W/VAS FL","code_information":[{"code":"19075","type":"CDM"},{"code":"341","type":"RC"},{"code":"78013","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1414.72,"discounted_cash":707.36,"setting":"both","billing_class":"facility"}]},{"description":"THYROID IMG SGL/MLT","code_information":[{"code":"19076","type":"CDM"},{"code":"341","type":"RC"},{"code":"78014","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1461.38,"discounted_cash":730.69,"setting":"both","billing_class":"facility"}]},{"description":"PARATHYROID IMAGING","code_information":[{"code":"19080","type":"CDM"},{"code":"341","type":"RC"},{"code":"78070","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":2190.06,"discounted_cash":1095.03,"setting":"both","billing_class":"facility"}]},{"description":"LYMPH SYSTEM IMAGING","code_information":[{"code":"19096","type":"CDM"},{"code":"341","type":"RC"},{"code":"78195","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":920.85,"discounted_cash":460.43,"setting":"both","billing_class":"facility"}]},{"description":"INJ ID BR SENT NODE","code_information":[{"code":"19097","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":773.87,"discounted_cash":386.94,"setting":"both","billing_class":"facility"}]},{"description":"LIVER IMAGING (3D)","code_information":[{"code":"19100","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.86,"discounted_cash":949.93,"setting":"both","billing_class":"facility"}]},{"description":"LIVER & SPLEEN IMAGI","code_information":[{"code":"19102","type":"CDM"},{"code":"341","type":"RC"},{"code":"78215","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1213.3,"discounted_cash":606.65,"setting":"both","billing_class":"facility"}]},{"description":"NM HIDA SCAN INCL GB","code_information":[{"code":"19106","type":"CDM"},{"code":"341","type":"RC"},{"code":"78226","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1097.04,"discounted_cash":548.52,"setting":"both","billing_class":"facility"}]},{"description":"NM HIDA SCAN W/PHARM","code_information":[{"code":"19107","type":"CDM"},{"code":"341","type":"RC"},{"code":"78227","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1258.65,"discounted_cash":629.33,"setting":"both","billing_class":"facility"}]},{"description":"GASTRIC EMPTYING STU","code_information":[{"code":"19114","type":"CDM"},{"code":"341","type":"RC"},{"code":"78264","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1742.33,"discounted_cash":871.16,"setting":"both","billing_class":"facility"}]},{"description":"NM BREATH TST C-14","code_information":[{"code":"19115","type":"CDM"},{"code":"300","type":"RC"},{"code":"78268","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":311.2,"discounted_cash":155.6,"setting":"both","billing_class":"facility"}]},{"description":"ACUT GI BLOOD LOSS","code_information":[{"code":"19119","type":"CDM"},{"code":"341","type":"RC"},{"code":"78278","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":927.44,"discounted_cash":463.72,"setting":"both","billing_class":"facility"}]},{"description":"MECKEL'S DIVERT EXAM","code_information":[{"code":"19121","type":"CDM"},{"code":"341","type":"RC"},{"code":"78290","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":791.59,"discounted_cash":395.8,"setting":"both","billing_class":"facility"}]},{"description":"BONE/JOINT LMTD","code_information":[{"code":"19123","type":"CDM"},{"code":"341","type":"RC"},{"code":"78300","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1213.3,"discounted_cash":606.65,"setting":"both","billing_class":"facility"}]},{"description":"BONE /JOINT MULTI","code_information":[{"code":"19124","type":"CDM"},{"code":"341","type":"RC"},{"code":"78305","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1159.85,"discounted_cash":579.92,"setting":"both","billing_class":"facility"}]},{"description":"BONE/JOINT WHOLE BDY","code_information":[{"code":"19125","type":"CDM"},{"code":"341","type":"RC"},{"code":"78306","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.62,"discounted_cash":894.31,"setting":"both","billing_class":"facility"}]},{"description":"BONE IMAGING 3 PHASE","code_information":[{"code":"19126","type":"CDM"},{"code":"341","type":"RC"},{"code":"78315","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1589.92,"discounted_cash":794.96,"setting":"both","billing_class":"facility"}]},{"description":"BONE IMAGING (3D)","code_information":[{"code":"19127","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1203.27,"discounted_cash":601.63,"setting":"both","billing_class":"facility"}]},{"description":"NM CARDIOLITE TREAD","code_information":[{"code":"19134","type":"CDM"},{"code":"341","type":"RC"},{"code":"78452","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":3395.47,"discounted_cash":1697.73,"setting":"both","billing_class":"facility"}]},{"description":"STENT LIFE 6X40/60","code_information":[{"code":"19135","type":"CDM"},{"code":"341","type":"RC"},{"code":"78454","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":2401.46,"discounted_cash":1200.73,"setting":"both","billing_class":"facility"}]},{"description":"NM MYO SPECT RST/STR","code_information":[{"code":"19138","type":"CDM"},{"code":"341","type":"RC"},{"code":"78451","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":3353.41,"discounted_cash":1676.7,"setting":"both","billing_class":"facility"}]},{"description":"NM MYO SPECT R/S MLT","code_information":[{"code":"19139","type":"CDM"},{"code":"341","type":"RC"},{"code":"78453","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1675.66,"discounted_cash":837.83,"setting":"both","billing_class":"facility"}]},{"description":"HEART INFARCT IMAGE","code_information":[{"code":"19140","type":"CDM"},{"code":"341","type":"RC"},{"code":"78466","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":759.98,"discounted_cash":379.99,"setting":"both","billing_class":"facility"}]},{"description":"GATED HEART RESTING","code_information":[{"code":"19143","type":"CDM"},{"code":"341","type":"RC"},{"code":"78472","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1975.47,"discounted_cash":987.74,"setting":"both","billing_class":"facility"}]},{"description":"LUNG PERFUSION IMAGI","code_information":[{"code":"19147","type":"CDM"},{"code":"341","type":"RC"},{"code":"78580","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":806.84,"discounted_cash":403.42,"setting":"both","billing_class":"facility"}]},{"description":"NM LUNG VENT/PERFSN","code_information":[{"code":"19148","type":"CDM"},{"code":"341","type":"RC"},{"code":"78582","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1097.04,"discounted_cash":548.52,"setting":"both","billing_class":"facility"}]},{"description":"NM LUNG PERFSN DIFF","code_information":[{"code":"19158","type":"CDM"},{"code":"341","type":"RC"},{"code":"78597","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1048.71,"discounted_cash":524.36,"setting":"both","billing_class":"facility"}]},{"description":"NM LUNG PERF/VNT DIF","code_information":[{"code":"19159","type":"CDM"},{"code":"341","type":"RC"},{"code":"78598","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1203.27,"discounted_cash":601.63,"setting":"both","billing_class":"facility"}]},{"description":"BRAIN COMP SPECT","code_information":[{"code":"19164","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":2153.17,"discounted_cash":1076.59,"setting":"both","billing_class":"facility"}]},{"description":"KIDNEY FLOW & FX IMA","code_information":[{"code":"19175","type":"CDM"},{"code":"341","type":"RC"},{"code":"78707","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1494.25,"discounted_cash":747.13,"setting":"both","billing_class":"facility"}]},{"description":"KIDNY VAS SING W/ PH","code_information":[{"code":"19176","type":"CDM"},{"code":"341","type":"RC"},{"code":"78708","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1803.2,"discounted_cash":901.6,"setting":"both","billing_class":"facility"}]},{"description":"KIDNEY VAS MULT W/WO","code_information":[{"code":"19177","type":"CDM"},{"code":"341","type":"RC"},{"code":"78709","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1494.25,"discounted_cash":747.13,"setting":"both","billing_class":"facility"}]},{"description":"KIDNEY IMAGING SPECT","code_information":[{"code":"19178","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1494.25,"discounted_cash":747.13,"setting":"both","billing_class":"facility"}]},{"description":"NM CARDIAC AMYLOID","code_information":[{"code":"19179","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":2278.0,"discounted_cash":1139.0,"setting":"both","billing_class":"facility"}]},{"description":"TUMOR IMAGING LTD AR","code_information":[{"code":"19186","type":"CDM"},{"code":"341","type":"RC"},{"code":"78800","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":949.96,"discounted_cash":474.98,"setting":"both","billing_class":"facility"}]},{"description":"TUMOR IMAG MULTI","code_information":[{"code":"19187","type":"CDM"},{"code":"341","type":"RC"},{"code":"78801","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1159.85,"discounted_cash":579.92,"setting":"both","billing_class":"facility"}]},{"description":"TUMR IMG 2/MORE DAY","code_information":[{"code":"19189","type":"CDM"},{"code":"341","type":"RC"},{"code":"78804","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":2216.5,"discounted_cash":1108.25,"setting":"both","billing_class":"facility"}]},{"description":"RDPHARM LOC INFL WB","code_information":[{"code":"19193","type":"CDM"},{"code":"341","type":"RC"},{"code":"78300","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":3245.93,"discounted_cash":1622.96,"setting":"both","billing_class":"facility"}]},{"description":"I-131 TX CAP PER MCI","code_information":[{"code":"19195","type":"CDM"},{"code":"344","type":"RC"},{"code":"A9517","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":265.01,"discounted_cash":132.5,"setting":"both","billing_class":"facility"}]},{"description":"GALLIUM CITRATE GA67","code_information":[{"code":"19208","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9556","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.85,"discounted_cash":42.42,"setting":"both","billing_class":"facility"}]},{"description":"I-123 NAI CAPSULE","code_information":[{"code":"19209","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9516","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":198.71,"discounted_cash":99.36,"setting":"both","billing_class":"facility"}]},{"description":"MAG-3","code_information":[{"code":"19217","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9562","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":596.17,"discounted_cash":298.08,"setting":"both","billing_class":"facility"}]},{"description":"TC-99M CHOLETEC","code_information":[{"code":"19218","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9537","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":218.61,"discounted_cash":109.31,"setting":"both","billing_class":"facility"}]},{"description":"TC-99M MAA","code_information":[{"code":"19224","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9540","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.44,"discounted_cash":41.72,"setting":"both","billing_class":"facility"}]},{"description":"TECH 99M PYP","code_information":[{"code":"19225","type":"CDM"},{"code":"341","type":"RC"},{"code":"A9538","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility"}]},{"description":"TC-99M MDP","code_information":[{"code":"19226","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9503","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":91.49,"discounted_cash":45.74,"setting":"both","billing_class":"facility"}]},{"description":"TC-99M NA PERTECHNET","code_information":[{"code":"19228","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9512","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.51,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"TC-99M SULFUR COLLOI","code_information":[{"code":"19231","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9541","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility"}]},{"description":"ULTRATAG","code_information":[{"code":"19232","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9560","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":370.98,"discounted_cash":185.49,"setting":"both","billing_class":"facility"}]},{"description":"XENON-133 GAS","code_information":[{"code":"19233","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9558","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":135.17,"discounted_cash":67.58,"setting":"both","billing_class":"facility"}]},{"description":"TC-99M SESTAMIBI CAR","code_information":[{"code":"19235","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9500","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":492.87,"discounted_cash":246.44,"setting":"both","billing_class":"facility"}]},{"description":"THALLIUM CHLORIDE","code_information":[{"code":"19238","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9505","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":127.96,"discounted_cash":63.98,"setting":"both","billing_class":"facility"}]},{"description":"NM PARATHYROID LOCAL","code_information":[{"code":"19243","type":"CDM"},{"code":"341","type":"RC"},{"code":"78808","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":879.0,"discounted_cash":439.5,"setting":"both","billing_class":"facility"}]},{"description":"UREA BREATH TEST ACQ","code_information":[{"code":"19244","type":"CDM"},{"code":"300","type":"RC"},{"code":"78267","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":276.4,"discounted_cash":138.2,"setting":"both","billing_class":"facility"}]},{"description":"RADIOPHARM TX ORAL","code_information":[{"code":"19253","type":"CDM"},{"code":"342","type":"RC"},{"code":"79005","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":916.88,"discounted_cash":458.44,"setting":"both","billing_class":"facility"}]},{"description":"G1001 EVICORE","code_information":[{"code":"19255","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1001","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1002 MEDCURRENT","code_information":[{"code":"19256","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1002","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1003 MEDICALIS","code_information":[{"code":"19257","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1003","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1004 NTL DECISION","code_information":[{"code":"19258","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1004","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1007 AIM SPECIALTY","code_information":[{"code":"19259","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1007","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1008 CRANBERRY PEAK","code_information":[{"code":"19260","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1008","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1010 STANSON","code_information":[{"code":"19262","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1010","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1011 QLFD TOOL OTHR","code_information":[{"code":"19263","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1011","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1012 AGILEMD","code_information":[{"code":"19264","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1012","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1013 EVIDENCECARE","code_information":[{"code":"19265","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1013","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1014 INVENIQA SEMAN","code_information":[{"code":"19266","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1014","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1015 RELIANT MED GR","code_information":[{"code":"19267","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1015","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1016 SPEED OF CARE","code_information":[{"code":"19268","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1016","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1017 HEALTHHELP","code_information":[{"code":"19269","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1017","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1018 INFINX CDSM","code_information":[{"code":"19270","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1018","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1019 LOGICNETS","code_information":[{"code":"19271","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1019","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1020 CURBSIDE","code_information":[{"code":"19272","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1020","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1021 EHEALTHLINE","code_information":[{"code":"19273","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1021","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1022 INTERMOUNTAIN","code_information":[{"code":"19274","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1022","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1023 PERSIVIA","code_information":[{"code":"19275","type":"CDM"},{"code":"349","type":"RC"},{"code":"G1023","type":"HCPCS"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"NM MI SPECT","code_information":[{"code":"19276","type":"CDM"},{"code":"341","type":"RC"},{"code":"78469","type":"CPT"},{"code":"760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1641.49,"discounted_cash":820.75,"setting":"both","billing_class":"facility"}]},{"description":"ADVNCD CARE PLAN 30","code_information":[{"code":"19278","type":"CDM"},{"code":"761","type":"RC"},{"code":"99497","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":68.75,"setting":"both","billing_class":"facility"}]},{"description":"ADV CARE PLAN ADD 30","code_information":[{"code":"19279","type":"CDM"},{"code":"761","type":"RC"},{"code":"99498","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":68.75,"setting":"both","billing_class":"facility"}]},{"description":"SIMULATION SIMPLE","code_information":[{"code":"19280","type":"CDM"},{"code":"333","type":"RC"},{"code":"77280","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":1203.9,"discounted_cash":601.95,"setting":"both","billing_class":"facility"}]},{"description":"SIMULATION INTERMED","code_information":[{"code":"19282","type":"CDM"},{"code":"333","type":"RC"},{"code":"77285","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":2933.37,"discounted_cash":1466.68,"setting":"both","billing_class":"facility"}]},{"description":"SIMULATION COMPLEX","code_information":[{"code":"19283","type":"CDM"},{"code":"333","type":"RC"},{"code":"77290","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":3039.8,"discounted_cash":1519.9,"setting":"both","billing_class":"facility"}]},{"description":"SIMULATION 3D","code_information":[{"code":"19284","type":"CDM"},{"code":"333","type":"RC"},{"code":"77295","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":10561.87,"discounted_cash":5280.94,"setting":"both","billing_class":"facility"}]},{"description":"BASIC DOSIMETRY CALC","code_information":[{"code":"19286","type":"CDM"},{"code":"333","type":"RC"},{"code":"77300","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":847.94,"discounted_cash":423.97,"setting":"both","billing_class":"facility"}]},{"description":"TELETHERAPY COMPLX","code_information":[{"code":"19294","type":"CDM"},{"code":"333","type":"RC"},{"code":"77307","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":1466.58,"discounted_cash":733.29,"setting":"both","billing_class":"facility"}]},{"description":"NON-PHYSCAN PRO VIST","code_information":[{"code":"19300","type":"CDM"},{"code":"761","type":"RC"},{"code":"99211","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":127.25,"discounted_cash":63.63,"setting":"both","billing_class":"facility"}]},{"description":"DOSIMETRY SPCL","code_information":[{"code":"19305","type":"CDM"},{"code":"333","type":"RC"},{"code":"77331","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":861.3,"discounted_cash":430.65,"setting":"both","billing_class":"facility"}]},{"description":"TX DEVICE SIMPLE","code_information":[{"code":"19307","type":"CDM"},{"code":"333","type":"RC"},{"code":"77332","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":1175.9,"discounted_cash":587.95,"setting":"both","billing_class":"facility"}]},{"description":"TX DEVICE COMPLX","code_information":[{"code":"19309","type":"CDM"},{"code":"333","type":"RC"},{"code":"77334","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":2165.19,"discounted_cash":1082.6,"setting":"both","billing_class":"facility"}]},{"description":"CONT MED PHYSICS CNS","code_information":[{"code":"19310","type":"CDM"},{"code":"333","type":"RC"},{"code":"77336","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.98,"discounted_cash":399.99,"setting":"both","billing_class":"facility"}]},{"description":"SPCL MED PHYSICS CNS","code_information":[{"code":"19311","type":"CDM"},{"code":"333","type":"RC"},{"code":"77370","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":938.51,"discounted_cash":469.25,"setting":"both","billing_class":"facility"}]},{"description":"PHYSICS UNLISTED","code_information":[{"code":"19312","type":"CDM"},{"code":"333","type":"RC"},{"code":"77399","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":386.28,"discounted_cash":193.14,"setting":"both","billing_class":"facility"}]},{"description":"RAD TX SIMPLE 6-10 M","code_information":[{"code":"19314","type":"CDM"},{"code":"333","type":"RC"},{"code":"77402","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":956.23,"discounted_cash":478.12,"setting":"both","billing_class":"facility"}]},{"description":"RAD TX CMPLX COMPLEX","code_information":[{"code":"19320","type":"CDM"},{"code":"333","type":"RC"},{"code":"77412","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":1679.87,"discounted_cash":839.93,"setting":"both","billing_class":"facility"}]},{"description":"TELTHRPY PLAN SIM","code_information":[{"code":"19321","type":"CDM"},{"code":"333","type":"RC"},{"code":"77306","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":949.96,"discounted_cash":474.98,"setting":"both","billing_class":"facility"}]},{"description":"BRACHTHY PLN SIM","code_information":[{"code":"19322","type":"CDM"},{"code":"333","type":"RC"},{"code":"77316","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":446.79,"discounted_cash":223.4,"setting":"both","billing_class":"facility"}]},{"description":"BRACHTHY PLN INT","code_information":[{"code":"19323","type":"CDM"},{"code":"333","type":"RC"},{"code":"77317","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":1086.7,"discounted_cash":543.35,"setting":"both","billing_class":"facility"}]},{"description":"BRACHTHY PLN COM","code_information":[{"code":"19324","type":"CDM"},{"code":"333","type":"RC"},{"code":"77318","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":1086.7,"discounted_cash":543.35,"setting":"both","billing_class":"facility"}]},{"description":"SPEC TELETHRPY PRT","code_information":[{"code":"19325","type":"CDM"},{"code":"333","type":"RC"},{"code":"77321","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":1143.89,"discounted_cash":571.95,"setting":"both","billing_class":"facility"}]},{"description":"TREAT DEV DSN CONST","code_information":[{"code":"19326","type":"CDM"},{"code":"333","type":"RC"},{"code":"77333","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":607.93,"discounted_cash":303.96,"setting":"both","billing_class":"facility"}]},{"description":"SPEC TREATMENT PROC","code_information":[{"code":"19327","type":"CDM"},{"code":"333","type":"RC"},{"code":"77470","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":1689.82,"discounted_cash":844.91,"setting":"both","billing_class":"facility"}]},{"description":"INTRAOP RAD TREATMNT","code_information":[{"code":"19328","type":"CDM"},{"code":"333","type":"RC"},{"code":"77425","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":13299.04,"discounted_cash":6649.52,"setting":"both","billing_class":"facility"}]},{"description":"THER RAD PORT FILM","code_information":[{"code":"19330","type":"CDM"},{"code":"333","type":"RC"},{"code":"77417","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":466.62,"discounted_cash":233.31,"setting":"both","billing_class":"facility"}]},{"description":"CT SCAN FOR TX GUIDE","code_information":[{"code":"19358","type":"CDM"},{"code":"333","type":"RC"},{"code":"77014","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":979.88,"discounted_cash":489.94,"setting":"both","billing_class":"facility"}]},{"description":"IMRT DELIVERY SIMPLE","code_information":[{"code":"19360","type":"CDM"},{"code":"333","type":"RC"},{"code":"77385","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":1813.52,"discounted_cash":906.76,"setting":"both","billing_class":"facility"}]},{"description":"IMRT DELIVERY CMPLEX","code_information":[{"code":"19361","type":"CDM"},{"code":"333","type":"RC"},{"code":"77386","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":1813.52,"discounted_cash":906.76,"setting":"both","billing_class":"facility"}]},{"description":"STEREOSCOPIC GUIDE","code_information":[{"code":"19362","type":"CDM"},{"code":"333","type":"RC"},{"code":"77387","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":397.67,"discounted_cash":198.84,"setting":"both","billing_class":"facility"}]},{"description":"IMRT PLAN","code_information":[{"code":"19363","type":"CDM"},{"code":"333","type":"RC"},{"code":"77301","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":6368.84,"discounted_cash":3184.42,"setting":"both","billing_class":"facility"}]},{"description":"DESGN MLC DEV F/IMRT","code_information":[{"code":"19364","type":"CDM"},{"code":"333","type":"RC"},{"code":"77338","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":1053.25,"discounted_cash":526.63,"setting":"both","billing_class":"facility"}]},{"description":"RESPIR MOTION MGMT","code_information":[{"code":"19365","type":"CDM"},{"code":"333","type":"RC"},{"code":"77293","type":"CPT"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":2872.6,"discounted_cash":1436.3,"setting":"both","billing_class":"facility"}]},{"description":"G1001 EVICORE","code_information":[{"code":"19367","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1001","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1002 MEDCURRENT","code_information":[{"code":"19368","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1002","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1003 MEDICALIS","code_information":[{"code":"19369","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1003","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1004 NTL DECISION","code_information":[{"code":"19370","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1004","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1007 AIM SPECIALTY","code_information":[{"code":"19371","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1007","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1008 CRANBERRY PEAK","code_information":[{"code":"19372","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1008","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1010 STANSON","code_information":[{"code":"19374","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1010","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1011 QLFD TOOL OTHR","code_information":[{"code":"19375","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1011","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1012 AGILEMD","code_information":[{"code":"19376","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1012","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1013 EVIDENCECARE","code_information":[{"code":"19377","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1013","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1014 INVENIQA SEMAN","code_information":[{"code":"19378","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1014","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1015 RELIANT MED GR","code_information":[{"code":"19379","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1015","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1016 SPEED OF CARE","code_information":[{"code":"19380","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1016","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1017 HEALTHHELP","code_information":[{"code":"19381","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1017","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1018 INFINX CDSM","code_information":[{"code":"19382","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1018","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1019 LOGICNETS","code_information":[{"code":"19383","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1019","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1020 CURBSIDE","code_information":[{"code":"19384","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1020","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1021 EHEALTHLINE","code_information":[{"code":"19385","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1021","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1022 INTERMOUNTAIN","code_information":[{"code":"19386","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1022","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"G1023 PERSIVIA","code_information":[{"code":"19387","type":"CDM"},{"code":"619","type":"RC"},{"code":"G1023","type":"HCPCS"},{"code":"741","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"THORACIC AORTOGRM","code_information":[{"code":"19388","type":"CDM"},{"code":"323","type":"RC"},{"code":"75605","type":"CPT"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":10701.95,"discounted_cash":5350.98,"setting":"both","billing_class":"facility"}]},{"description":"OT EVAL LTD","code_information":[{"code":"19405","type":"CDM"},{"code":"434","type":"RC"},{"code":"97165","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.75,"discounted_cash":150.38,"setting":"both","billing_class":"facility"}]},{"description":"OT EVAL INT","code_information":[{"code":"19406","type":"CDM"},{"code":"434","type":"RC"},{"code":"97166","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.75,"discounted_cash":150.38,"setting":"both","billing_class":"facility"}]},{"description":"OT EVAL EXT","code_information":[{"code":"19407","type":"CDM"},{"code":"434","type":"RC"},{"code":"97167","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":356.4,"discounted_cash":178.2,"setting":"both","billing_class":"facility"}]},{"description":"OT RE-EVAL","code_information":[{"code":"19411","type":"CDM"},{"code":"434","type":"RC"},{"code":"97168","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.44,"discounted_cash":41.72,"setting":"both","billing_class":"facility"}]},{"description":"ELEC STIM UNAT VISIT","code_information":[{"code":"19415","type":"CDM"},{"code":"430","type":"RC"},{"code":"G0283","type":"HCPCS"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":145.73,"discounted_cash":72.86,"setting":"both","billing_class":"facility"}]},{"description":"WHIRLPOOL/ VISIT","code_information":[{"code":"19419","type":"CDM"},{"code":"430","type":"RC"},{"code":"97022","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":178.9,"discounted_cash":89.45,"setting":"both","billing_class":"facility"}]},{"description":"ELEC STIM MAN 15 MIN","code_information":[{"code":"19423","type":"CDM"},{"code":"430","type":"RC"},{"code":"97032","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":145.73,"discounted_cash":72.86,"setting":"both","billing_class":"facility"}]},{"description":"IONTOPHORESIS/15 MIN","code_information":[{"code":"19424","type":"CDM"},{"code":"430","type":"RC"},{"code":"97033","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":213.28,"discounted_cash":106.64,"setting":"both","billing_class":"facility"}]},{"description":"ULTRASOUND/15 MIN","code_information":[{"code":"19426","type":"CDM"},{"code":"430","type":"RC"},{"code":"97035","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":141.7,"discounted_cash":70.85,"setting":"both","billing_class":"facility"}]},{"description":"THER EXER/15 MIN","code_information":[{"code":"19431","type":"CDM"},{"code":"430","type":"RC"},{"code":"97110","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":188.1,"discounted_cash":94.05,"setting":"both","billing_class":"facility"}]},{"description":"NEURO RE-ED/15 MIN","code_information":[{"code":"19432","type":"CDM"},{"code":"430","type":"RC"},{"code":"97112","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.93,"discounted_cash":54.97,"setting":"both","billing_class":"facility"}]},{"description":"MASSAGE/15 MIN","code_information":[{"code":"19435","type":"CDM"},{"code":"430","type":"RC"},{"code":"97124","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.6,"discounted_cash":41.8,"setting":"both","modifier_code":["97","32"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 97: Rehabilitative Services | Modifier 32: Mandated Services"}]},{"description":"MANUAL THER/15 MIN","code_information":[{"code":"19437","type":"CDM"},{"code":"430","type":"RC"},{"code":"97140","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":185.44,"discounted_cash":92.72,"setting":"both","billing_class":"facility"}]},{"description":"ORTHO MGMT TRN 15MIN","code_information":[{"code":"19439","type":"CDM"},{"code":"430","type":"RC"},{"code":"97760","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.22,"discounted_cash":35.11,"setting":"both","billing_class":"facility"}]},{"description":"THERAPACT/15 MIN","code_information":[{"code":"19441","type":"CDM"},{"code":"430","type":"RC"},{"code":"97530","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.44,"discounted_cash":41.72,"setting":"both","billing_class":"facility"}]},{"description":"SENSORY TRN/15 MIN","code_information":[{"code":"19443","type":"CDM"},{"code":"430","type":"RC"},{"code":"97533","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.23,"discounted_cash":38.62,"setting":"both","billing_class":"facility"}]},{"description":"ADL/15 MIN","code_information":[{"code":"19446","type":"CDM"},{"code":"430","type":"RC"},{"code":"97535","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.37,"discounted_cash":25.18,"setting":"both","billing_class":"facility"}]},{"description":"WHEELCHAIR TRN/15 MI","code_information":[{"code":"19449","type":"CDM"},{"code":"430","type":"RC"},{"code":"97542","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.21,"discounted_cash":36.1,"setting":"both","billing_class":"facility"}]},{"description":"PROS/ORTHO CKOUT 15M","code_information":[{"code":"19457","type":"CDM"},{"code":"430","type":"RC"},{"code":"97763","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.02,"discounted_cash":31.01,"setting":"both","billing_class":"facility"}]},{"description":"FCE 15MIN","code_information":[{"code":"19459","type":"CDM"},{"code":"430","type":"RC"},{"code":"97750","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.87,"discounted_cash":51.94,"setting":"both","billing_class":"facility"}]},{"description":"APP SPL LONG ARM","code_information":[{"code":"19464","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":333.3,"discounted_cash":166.65,"setting":"both","billing_class":"facility"}]},{"description":"APP SPL SHRT ARM ST","code_information":[{"code":"19465","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":378.15,"discounted_cash":189.07,"setting":"both","billing_class":"facility"}]},{"description":"APP SPL SHRT ARM DYN","code_information":[{"code":"19466","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":177.5,"setting":"both","billing_class":"facility"}]},{"description":"APP SPL FINGER ST","code_information":[{"code":"19467","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":290.9,"discounted_cash":145.45,"setting":"both","billing_class":"facility"}]},{"description":"THER IVNTJ 1ST 15 MI","code_information":[{"code":"19481","type":"CDM"},{"code":"430","type":"RC"},{"code":"97129","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.25,"discounted_cash":51.13,"setting":"both","billing_class":"facility"}]},{"description":"THER IVNTJ ADDL 15","code_information":[{"code":"19482","type":"CDM"},{"code":"430","type":"RC"},{"code":"97130","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":99.07,"discounted_cash":49.53,"setting":"both","billing_class":"facility"}]},{"description":"SELF CARE 15 MIN","code_information":[{"code":"19503","type":"CDM"},{"code":"430","type":"RC"},{"code":"97535","type":"CPT"},{"code":"642","type":"LOCAL"}],"standard_charges":[{"gross_charge":45.56,"discounted_cash":22.78,"setting":"both","billing_class":"facility"}]},{"description":"PULMONARY STRESS TST","code_information":[{"code":"19837","type":"CDM"},{"code":"460","type":"RC"},{"code":"94618","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":421.34,"discounted_cash":210.67,"setting":"both","billing_class":"facility"}]},{"description":"ADVNCD CARE PLAN 30","code_information":[{"code":"19838","type":"CDM"},{"code":"761","type":"RC"},{"code":"99497","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":68.75,"setting":"both","billing_class":"facility"}]},{"description":"ADV CARE PLAN ADD 30","code_information":[{"code":"19839","type":"CDM"},{"code":"761","type":"RC"},{"code":"99498","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":68.75,"setting":"both","billing_class":"facility"}]},{"description":"DMST GROUP PER 30MIN","code_information":[{"code":"19840","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0109","type":"HCPCS"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.51,"discounted_cash":29.75,"setting":"both","billing_class":"facility"}]},{"description":"DMST IND 30 MIN (RD)","code_information":[{"code":"19841","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":121.59,"discounted_cash":60.8,"setting":"both","billing_class":"facility"}]},{"description":"DMST IND 30 MIN (RN)","code_information":[{"code":"19842","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":127.23,"discounted_cash":63.62,"setting":"both","billing_class":"facility"}]},{"description":"THER/PRPH/DIG INJ SC","code_information":[{"code":"19844","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.25,"discounted_cash":88.13,"setting":"both","billing_class":"facility"}]},{"description":"THER/PRPH/DX INJ IA","code_information":[{"code":"19845","type":"CDM"},{"code":"260","type":"RC"},{"code":"96373","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":367.25,"discounted_cash":183.63,"setting":"both","billing_class":"facility"}]},{"description":"THER/PRPH/DX INJ IV","code_information":[{"code":"19846","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.15,"discounted_cash":192.07,"setting":"both","billing_class":"facility"}]},{"description":"TX/PR/DX INJ NEW DRG","code_information":[{"code":"19847","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.25,"discounted_cash":88.13,"setting":"both","billing_class":"facility"}]},{"description":"TX/PRO/DX IV INF 1ST","code_information":[{"code":"19848","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":718.9,"discounted_cash":359.45,"setting":"both","billing_class":"facility"}]},{"description":"TX/PRO/DX IV INF ADD","code_information":[{"code":"19849","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":168.45,"discounted_cash":84.22,"setting":"both","billing_class":"facility"}]},{"description":"TX/PR/DX ADD SEQ INF","code_information":[{"code":"19850","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.25,"discounted_cash":101.13,"setting":"both","billing_class":"facility"}]},{"description":"INFSIN-CONCR NON CHM","code_information":[{"code":"19851","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":128.05,"discounted_cash":64.03,"setting":"both","billing_class":"facility"}]},{"description":"TX/PR/DX INJ/INF PRO","code_information":[{"code":"19852","type":"CDM"},{"code":"260","type":"RC"},{"code":"96379","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":122.45,"discounted_cash":61.23,"setting":"both","billing_class":"facility"}]},{"description":"NONCHEMO INJ IV SAME","code_information":[{"code":"19853","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":128.05,"discounted_cash":64.03,"setting":"both","billing_class":"facility"}]},{"description":"THERAPECT PHLEBOTOMY","code_information":[{"code":"19854","type":"CDM"},{"code":"940","type":"RC"},{"code":"99195","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.5,"discounted_cash":103.75,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO ANTI-NEO SQ/IM","code_information":[{"code":"19855","type":"CDM"},{"code":"331","type":"RC"},{"code":"96401","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":482.57,"discounted_cash":241.28,"setting":"both","billing_class":"facility"}]},{"description":"CHEM HORM ANTINEO SQ","code_information":[{"code":"19856","type":"CDM"},{"code":"331","type":"RC"},{"code":"96402","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":301.32,"discounted_cash":150.66,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO IVP SINGL DRUG","code_information":[{"code":"19857","type":"CDM"},{"code":"335","type":"RC"},{"code":"96409","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":859.88,"discounted_cash":429.94,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO IVP ADDL DRUG","code_information":[{"code":"19858","type":"CDM"},{"code":"335","type":"RC"},{"code":"96411","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":569.21,"discounted_cash":284.61,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO IV INF INIT HR","code_information":[{"code":"19859","type":"CDM"},{"code":"335","type":"RC"},{"code":"96413","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1729.0,"discounted_cash":864.5,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO IV INF ADDL HR","code_information":[{"code":"19860","type":"CDM"},{"code":"335","type":"RC"},{"code":"96415","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":262.4,"discounted_cash":131.2,"setting":"both","billing_class":"facility"}]},{"description":"CHEM IV INF ADDL SEQ","code_information":[{"code":"19861","type":"CDM"},{"code":"335","type":"RC"},{"code":"96417","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":262.4,"discounted_cash":131.2,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO IA PUSH TECHNI","code_information":[{"code":"19862","type":"CDM"},{"code":"335","type":"RC"},{"code":"96420","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1331.17,"discounted_cash":665.59,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO IA INF INIT HR","code_information":[{"code":"19863","type":"CDM"},{"code":"335","type":"RC"},{"code":"96422","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1331.17,"discounted_cash":665.59,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO IA INF ADDL HR","code_information":[{"code":"19864","type":"CDM"},{"code":"335","type":"RC"},{"code":"96423","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":201.37,"discounted_cash":100.69,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO INTRALESION <7","code_information":[{"code":"19865","type":"CDM"},{"code":"331","type":"RC"},{"code":"96405","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.05,"discounted_cash":101.03,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO INTRALESION >7","code_information":[{"code":"19866","type":"CDM"},{"code":"331","type":"RC"},{"code":"96406","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":822.0,"discounted_cash":411.0,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO INTRACAVITARY","code_information":[{"code":"19867","type":"CDM"},{"code":"331","type":"RC"},{"code":"96440","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1331.17,"discounted_cash":665.59,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO TX ADM PERITON","code_information":[{"code":"19868","type":"CDM"},{"code":"331","type":"RC"},{"code":"96446","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1331.17,"discounted_cash":665.59,"setting":"both","billing_class":"facility"}]},{"description":"CHEM INJ SUBAR/INTRA","code_information":[{"code":"19869","type":"CDM"},{"code":"331","type":"RC"},{"code":"96542","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":822.0,"discounted_cash":411.0,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO INTO CNS","code_information":[{"code":"19870","type":"CDM"},{"code":"331","type":"RC"},{"code":"96450","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1331.17,"discounted_cash":665.59,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO INFUS METHOD","code_information":[{"code":"19871","type":"CDM"},{"code":"335","type":"RC"},{"code":"96425","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1331.17,"discounted_cash":665.59,"setting":"both","billing_class":"facility"}]},{"description":"CHEM PROLON INF/PUMP","code_information":[{"code":"19872","type":"CDM"},{"code":"335","type":"RC"},{"code":"96416","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1331.17,"discounted_cash":665.59,"setting":"both","billing_class":"facility"}]},{"description":"REFIL/MAIN PORT PUMP","code_information":[{"code":"19873","type":"CDM"},{"code":"335","type":"RC"},{"code":"96521","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":683.01,"discounted_cash":341.5,"setting":"both","billing_class":"facility"}]},{"description":"REFIL/MAIN PUMP/RES","code_information":[{"code":"19874","type":"CDM"},{"code":"335","type":"RC"},{"code":"96522","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":683.01,"discounted_cash":341.5,"setting":"both","billing_class":"facility"}]},{"description":"CHEMOTHERAPY UNSPECI","code_information":[{"code":"19875","type":"CDM"},{"code":"330","type":"RC"},{"code":"96549","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":132.14,"discounted_cash":66.07,"setting":"both","billing_class":"facility"}]},{"description":"HYDRATION IV INF 1ST","code_information":[{"code":"19876","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.15,"discounted_cash":192.07,"setting":"both","billing_class":"facility"}]},{"description":"HYDRATION IV INF ADD","code_information":[{"code":"19877","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":66.15,"setting":"both","billing_class":"facility"}]},{"description":"VENIPUNCTURE","code_information":[{"code":"19878","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.65,"discounted_cash":15.32,"setting":"both","billing_class":"facility"}]},{"description":"BLD COLL IMP VEN DEV","code_information":[{"code":"19879","type":"CDM"},{"code":"300","type":"RC"},{"code":"36591","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":205.4,"discounted_cash":102.7,"setting":"both","billing_class":"facility"}]},{"description":"BLD COL CVC PICC PIV","code_information":[{"code":"19880","type":"CDM"},{"code":"300","type":"RC"},{"code":"36592","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":205.4,"discounted_cash":102.7,"setting":"both","billing_class":"facility"}]},{"description":"PORT/CATH/PICC FLUSH","code_information":[{"code":"19881","type":"CDM"},{"code":"761","type":"RC"},{"code":"96523","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.5,"discounted_cash":103.75,"setting":"both","billing_class":"facility"}]},{"description":"DECLOTTING VAD/CATH","code_information":[{"code":"19882","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":488.1,"discounted_cash":244.05,"setting":"both","billing_class":"facility"}]},{"description":"ULTRA POST VOID URIN","code_information":[{"code":"19883","type":"CDM"},{"code":"761","type":"RC"},{"code":"51798","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":198.35,"discounted_cash":99.17,"setting":"both","billing_class":"facility"}]},{"description":"INSERT FOL CATH SIMP","code_information":[{"code":"19884","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.45,"discounted_cash":190.22,"setting":"both","billing_class":"facility"}]},{"description":"INSERT FOL CATH COMP","code_information":[{"code":"19885","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":278.75,"discounted_cash":139.38,"setting":"both","billing_class":"facility"}]},{"description":"INSERT STRAIGHT CATH","code_information":[{"code":"19886","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":324.8,"discounted_cash":162.4,"setting":"both","billing_class":"facility"}]},{"description":"INJ APP ON BODY","code_information":[{"code":"19887","type":"CDM"},{"code":"260","type":"RC"},{"code":"96377","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":170.05,"discounted_cash":85.03,"setting":"both","billing_class":"facility"}]},{"description":"VACCINE ADMIN INIT","code_information":[{"code":"19888","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":156.28,"discounted_cash":78.14,"setting":"both","billing_class":"facility"}]},{"description":"VACCINE ADMIN EA ADD","code_information":[{"code":"19889","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"CPT"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":79.79,"discounted_cash":39.9,"setting":"both","billing_class":"facility"}]},{"description":"VACCINE ADMIN INFLU","code_information":[{"code":"19890","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":99.43,"discounted_cash":49.72,"setting":"both","billing_class":"facility"}]},{"description":"VACCINE ADMIN PNEUMO","code_information":[{"code":"19891","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":156.28,"discounted_cash":78.14,"setting":"both","billing_class":"facility"}]},{"description":"INSTLL CHEMO BLADDER","code_information":[{"code":"19892","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.34,"discounted_cash":420.17,"setting":"both","billing_class":"facility"}]},{"description":"BONE MARROW ASPIRATN","code_information":[{"code":"19893","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1685.0,"discounted_cash":842.5,"setting":"both","billing_class":"facility"}]},{"description":"BONE MARRW NEEDL BIO","code_information":[{"code":"19894","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":3461.3,"discounted_cash":1730.65,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO EXTND IV INFUS","code_information":[{"code":"19895","type":"CDM"},{"code":"280","type":"RC"},{"code":"G0498","type":"HCPCS"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1043.95,"discounted_cash":521.98,"setting":"both","billing_class":"facility"}]},{"description":"NON-PHYSCAN PRO VIST","code_information":[{"code":"19897","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"361","type":"LOCAL"}],"standard_charges":[{"gross_charge":133.15,"discounted_cash":66.58,"setting":"both","billing_class":"facility"}]},{"description":"MRI ORB/FACE/NCK WO","code_information":[{"code":"19898","type":"CDM"},{"code":"611","type":"RC"},{"code":"70540","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3104.38,"discounted_cash":1552.19,"setting":"both","billing_class":"facility"}]},{"description":"MRI ORB/FACE/NCK W","code_information":[{"code":"19899","type":"CDM"},{"code":"611","type":"RC"},{"code":"70542","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3104.38,"discounted_cash":1552.19,"setting":"both","billing_class":"facility"}]},{"description":"MRI ORB/FCE/NCK WO/W","code_information":[{"code":"19900","type":"CDM"},{"code":"611","type":"RC"},{"code":"70543","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3206.95,"discounted_cash":1603.47,"setting":"both","billing_class":"facility"}]},{"description":"MRA HEAD WO","code_information":[{"code":"19901","type":"CDM"},{"code":"615","type":"RC"},{"code":"70544","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2405.22,"discounted_cash":1202.61,"setting":"both","billing_class":"facility"}]},{"description":"MRA HEAD W","code_information":[{"code":"19902","type":"CDM"},{"code":"615","type":"RC"},{"code":"70545","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3165.51,"discounted_cash":1582.76,"setting":"both","billing_class":"facility"}]},{"description":"MRA HEAD WO/W","code_information":[{"code":"19903","type":"CDM"},{"code":"615","type":"RC"},{"code":"70546","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":4507.71,"discounted_cash":2253.86,"setting":"both","billing_class":"facility"}]},{"description":"MRA NECK WO","code_information":[{"code":"19904","type":"CDM"},{"code":"615","type":"RC"},{"code":"70547","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2317.81,"discounted_cash":1158.9,"setting":"both","billing_class":"facility"}]},{"description":"MRA NECK W","code_information":[{"code":"19905","type":"CDM"},{"code":"615","type":"RC"},{"code":"70548","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3165.51,"discounted_cash":1582.76,"setting":"both","billing_class":"facility"}]},{"description":"MRA NECK WO/W","code_information":[{"code":"19906","type":"CDM"},{"code":"615","type":"RC"},{"code":"70549","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3210.92,"discounted_cash":1605.46,"setting":"both","billing_class":"facility"}]},{"description":"MRI BRAIN WO","code_information":[{"code":"19907","type":"CDM"},{"code":"611","type":"RC"},{"code":"70551","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3109.45,"discounted_cash":1554.72,"setting":"both","billing_class":"facility"}]},{"description":"MRI BRAIN W","code_information":[{"code":"19908","type":"CDM"},{"code":"611","type":"RC"},{"code":"70552","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2335.68,"discounted_cash":1167.84,"setting":"both","billing_class":"facility"}]},{"description":"MRI BRAIN WO/W","code_information":[{"code":"19909","type":"CDM"},{"code":"611","type":"RC"},{"code":"70553","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":4481.12,"discounted_cash":2240.56,"setting":"both","billing_class":"facility"}]},{"description":"MRI CHEST WO","code_information":[{"code":"19910","type":"CDM"},{"code":"610","type":"RC"},{"code":"71550","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3023.29,"discounted_cash":1511.64,"setting":"both","billing_class":"facility"}]},{"description":"MRI CHEST W","code_information":[{"code":"19911","type":"CDM"},{"code":"610","type":"RC"},{"code":"71551","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3023.29,"discounted_cash":1511.64,"setting":"both","billing_class":"facility"}]},{"description":"MRI CHEST WO/W","code_information":[{"code":"19912","type":"CDM"},{"code":"610","type":"RC"},{"code":"71552","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":4622.98,"discounted_cash":2311.49,"setting":"both","billing_class":"facility"}]},{"description":"MRI C-SPINE W/O","code_information":[{"code":"19913","type":"CDM"},{"code":"612","type":"RC"},{"code":"72141","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3300.68,"discounted_cash":1650.34,"setting":"both","billing_class":"facility"}]},{"description":"MRI C-SPINE W","code_information":[{"code":"19914","type":"CDM"},{"code":"612","type":"RC"},{"code":"72142","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3023.29,"discounted_cash":1511.64,"setting":"both","billing_class":"facility"}]},{"description":"MRI T-SPINE W/O","code_information":[{"code":"19915","type":"CDM"},{"code":"612","type":"RC"},{"code":"72146","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3412.19,"discounted_cash":1706.1,"setting":"both","billing_class":"facility"}]},{"description":"MRI T-SPINE W","code_information":[{"code":"19916","type":"CDM"},{"code":"612","type":"RC"},{"code":"72147","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3023.29,"discounted_cash":1511.64,"setting":"both","billing_class":"facility"}]},{"description":"MRI L-SPINE W/O","code_information":[{"code":"19917","type":"CDM"},{"code":"612","type":"RC"},{"code":"72148","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3333.6,"discounted_cash":1666.8,"setting":"both","billing_class":"facility"}]},{"description":"MRI L-SPINE W","code_information":[{"code":"19918","type":"CDM"},{"code":"612","type":"RC"},{"code":"72149","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3174.34,"discounted_cash":1587.17,"setting":"both","billing_class":"facility"}]},{"description":"MRI C-SPINE W/W/O","code_information":[{"code":"19919","type":"CDM"},{"code":"612","type":"RC"},{"code":"72156","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":4466.07,"discounted_cash":2233.03,"setting":"both","billing_class":"facility"}]},{"description":"MRI T-SPINE W WO","code_information":[{"code":"19920","type":"CDM"},{"code":"612","type":"RC"},{"code":"72157","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3853.18,"discounted_cash":1926.59,"setting":"both","billing_class":"facility"}]},{"description":"MRI L-SPINE W/W/O","code_information":[{"code":"19921","type":"CDM"},{"code":"612","type":"RC"},{"code":"72158","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":4425.42,"discounted_cash":2212.71,"setting":"both","billing_class":"facility"}]},{"description":"MRI PELVIS WO","code_information":[{"code":"19922","type":"CDM"},{"code":"610","type":"RC"},{"code":"72195","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2864.97,"discounted_cash":1432.48,"setting":"both","billing_class":"facility"}]},{"description":"MRI PELVIS W","code_information":[{"code":"19923","type":"CDM"},{"code":"610","type":"RC"},{"code":"72196","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3023.29,"discounted_cash":1511.64,"setting":"both","billing_class":"facility"}]},{"description":"MRI PELVIS WO/W","code_information":[{"code":"19924","type":"CDM"},{"code":"610","type":"RC"},{"code":"72197","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2954.89,"discounted_cash":1477.44,"setting":"both","billing_class":"facility"}]},{"description":"MRI UPPER EXT RT WO","code_information":[{"code":"19925","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3309.57,"discounted_cash":1654.79,"setting":"both","billing_class":"facility"}]},{"description":"MRI UPPER EXT RT W","code_information":[{"code":"19926","type":"CDM"},{"code":"610","type":"RC"},{"code":"73219","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3166.45,"discounted_cash":1583.22,"setting":"both","billing_class":"facility"}]},{"description":"MRI UPPR EXT RT WO/W","code_information":[{"code":"19927","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":4267.1,"discounted_cash":2133.55,"setting":"both","billing_class":"facility"}]},{"description":"MRI UPPER EXT LT WO","code_information":[{"code":"19928","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3309.57,"discounted_cash":1654.79,"setting":"both","billing_class":"facility"}]},{"description":"MRI UPPER EXT LT W","code_information":[{"code":"19929","type":"CDM"},{"code":"610","type":"RC"},{"code":"73219","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3166.45,"discounted_cash":1583.22,"setting":"both","billing_class":"facility"}]},{"description":"MRI UPPER EXT LT WO/","code_information":[{"code":"19930","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":4267.1,"discounted_cash":2133.55,"setting":"both","billing_class":"facility"}]},{"description":"MRI UPR EXT JNT LT W","code_information":[{"code":"19931","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3436.22,"discounted_cash":1718.11,"setting":"both","billing_class":"facility"}]},{"description":"MRI UPR EXT JNT LT W","code_information":[{"code":"19932","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2640.82,"discounted_cash":1320.41,"setting":"both","billing_class":"facility"}]},{"description":"MRI UPR EXT JT LT WO","code_information":[{"code":"19933","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":4622.98,"discounted_cash":2311.49,"setting":"both","billing_class":"facility"}]},{"description":"MRI UPPER EXT JNT RT","code_information":[{"code":"19934","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3436.22,"discounted_cash":1718.11,"setting":"both","billing_class":"facility"}]},{"description":"MRI UPR EXT JNT RT W","code_information":[{"code":"19935","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2640.82,"discounted_cash":1320.41,"setting":"both","billing_class":"facility"}]},{"description":"MRI UPR EXT JT RT WO","code_information":[{"code":"19936","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":4622.98,"discounted_cash":2311.49,"setting":"both","billing_class":"facility"}]},{"description":"MRI LOWER EXT RT WO","code_information":[{"code":"19937","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3144.88,"discounted_cash":1572.44,"setting":"both","billing_class":"facility"}]},{"description":"MRI LOWER EXT RT W","code_information":[{"code":"19938","type":"CDM"},{"code":"610","type":"RC"},{"code":"73719","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2842.19,"discounted_cash":1421.1,"setting":"both","billing_class":"facility"}]},{"description":"MRI LOWR EXT RT WO/W","code_information":[{"code":"19939","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3293.06,"discounted_cash":1646.53,"setting":"both","billing_class":"facility"}]},{"description":"MRI LOWER EXT LT WO","code_information":[{"code":"19940","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3144.88,"discounted_cash":1572.44,"setting":"both","billing_class":"facility"}]},{"description":"MRI LOWER EXT LT W","code_information":[{"code":"19941","type":"CDM"},{"code":"610","type":"RC"},{"code":"73719","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2842.19,"discounted_cash":1421.1,"setting":"both","billing_class":"facility"}]},{"description":"MRI LOWR EXT LT WO/W","code_information":[{"code":"19942","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3293.06,"discounted_cash":1646.53,"setting":"both","billing_class":"facility"}]},{"description":"MRI LE JNT WO LT","code_information":[{"code":"19943","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3414.69,"discounted_cash":1707.35,"setting":"both","billing_class":"facility"}]},{"description":"MRI LE JNT W/ LT","code_information":[{"code":"19944","type":"CDM"},{"code":"610","type":"RC"},{"code":"73722","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3174.34,"discounted_cash":1587.17,"setting":"both","billing_class":"facility"}]},{"description":"MRI LE JNT W/WO LT","code_information":[{"code":"19945","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3459.0,"discounted_cash":1729.5,"setting":"both","billing_class":"facility"}]},{"description":"MRI LE JNT WO RT","code_information":[{"code":"19946","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3414.69,"discounted_cash":1707.35,"setting":"both","billing_class":"facility"}]},{"description":"MRI LE JNT W/ RT","code_information":[{"code":"19947","type":"CDM"},{"code":"610","type":"RC"},{"code":"73722","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3174.34,"discounted_cash":1587.17,"setting":"both","billing_class":"facility"}]},{"description":"MRI LE JNT W/WO RT","code_information":[{"code":"19948","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3459.0,"discounted_cash":1729.5,"setting":"both","billing_class":"facility"}]},{"description":"MRI ABDOMEN WO","code_information":[{"code":"19949","type":"CDM"},{"code":"610","type":"RC"},{"code":"74181","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3208.25,"discounted_cash":1604.13,"setting":"both","billing_class":"facility"}]},{"description":"MRI ABDOMEN W","code_information":[{"code":"19950","type":"CDM"},{"code":"610","type":"RC"},{"code":"74182","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3174.34,"discounted_cash":1587.17,"setting":"both","billing_class":"facility"}]},{"description":"MRI ABDOMEN WO/W","code_information":[{"code":"19951","type":"CDM"},{"code":"610","type":"RC"},{"code":"74183","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3724.17,"discounted_cash":1862.09,"setting":"both","billing_class":"facility"}]},{"description":"CT ABD/PELVIS W","code_information":[{"code":"19952","type":"CDM"},{"code":"352","type":"RC"},{"code":"74177","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2753.52,"discounted_cash":1376.76,"setting":"both","billing_class":"facility"}]},{"description":"THORACIC SPINE  3 VW","code_information":[{"code":"19953","type":"CDM"},{"code":"320","type":"RC"},{"code":"72072","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":500.29,"discounted_cash":250.15,"setting":"both","billing_class":"facility"}]},{"description":"CT HEAD/BRAIN WO","code_information":[{"code":"19954","type":"CDM"},{"code":"351","type":"RC"},{"code":"70450","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1600.94,"discounted_cash":800.47,"setting":"both","billing_class":"facility"}]},{"description":"CT HEAD/BRAIN W","code_information":[{"code":"19955","type":"CDM"},{"code":"351","type":"RC"},{"code":"70460","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1556.63,"discounted_cash":778.32,"setting":"both","billing_class":"facility"}]},{"description":"CT HEAD/BRAIN WO/W","code_information":[{"code":"19956","type":"CDM"},{"code":"351","type":"RC"},{"code":"70470","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2377.38,"discounted_cash":1188.69,"setting":"both","billing_class":"facility"}]},{"description":"CT SELL/ORB/IAC WO","code_information":[{"code":"19957","type":"CDM"},{"code":"351","type":"RC"},{"code":"70480","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1684.54,"discounted_cash":842.27,"setting":"both","billing_class":"facility"}]},{"description":"CT SELL/ORB/IAC W","code_information":[{"code":"19958","type":"CDM"},{"code":"351","type":"RC"},{"code":"70481","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1873.27,"discounted_cash":936.63,"setting":"both","billing_class":"facility"}]},{"description":"CT SELL/ORB/IAC WO/W","code_information":[{"code":"19959","type":"CDM"},{"code":"351","type":"RC"},{"code":"70482","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2639.57,"discounted_cash":1319.79,"setting":"both","billing_class":"facility"}]},{"description":"CT MAXILLOFACIAL WO","code_information":[{"code":"19960","type":"CDM"},{"code":"351","type":"RC"},{"code":"70486","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1619.91,"discounted_cash":809.96,"setting":"both","billing_class":"facility"}]},{"description":"CT MAXILLOFACIAL W","code_information":[{"code":"19961","type":"CDM"},{"code":"351","type":"RC"},{"code":"70487","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1704.81,"discounted_cash":852.4,"setting":"both","billing_class":"facility"}]},{"description":"CT MAXILLOFACIAL WO/","code_information":[{"code":"19962","type":"CDM"},{"code":"351","type":"RC"},{"code":"70488","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2453.35,"discounted_cash":1226.67,"setting":"both","billing_class":"facility"}]},{"description":"CT SFT TISS/NECK WO","code_information":[{"code":"19963","type":"CDM"},{"code":"351","type":"RC"},{"code":"70490","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1573.09,"discounted_cash":786.54,"setting":"both","billing_class":"facility"}]},{"description":"CT SFT TISS/NECK W","code_information":[{"code":"19964","type":"CDM"},{"code":"351","type":"RC"},{"code":"70491","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1946.73,"discounted_cash":973.37,"setting":"both","billing_class":"facility"}]},{"description":"CT SFT TIS/NECK WO/W","code_information":[{"code":"19965","type":"CDM"},{"code":"351","type":"RC"},{"code":"70492","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2505.28,"discounted_cash":1252.64,"setting":"both","billing_class":"facility"}]},{"description":"CT THORAX WO","code_information":[{"code":"19966","type":"CDM"},{"code":"352","type":"RC"},{"code":"71250","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1878.34,"discounted_cash":939.17,"setting":"both","billing_class":"facility"}]},{"description":"CT THORAX W","code_information":[{"code":"19967","type":"CDM"},{"code":"352","type":"RC"},{"code":"71260","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2277.26,"discounted_cash":1138.63,"setting":"both","billing_class":"facility"}]},{"description":"CT THORAX WO/W","code_information":[{"code":"19968","type":"CDM"},{"code":"352","type":"RC"},{"code":"71270","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2283.64,"discounted_cash":1141.82,"setting":"both","billing_class":"facility"}]},{"description":"CTA CHEST WO/W","code_information":[{"code":"19969","type":"CDM"},{"code":"352","type":"RC"},{"code":"71275","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2939.69,"discounted_cash":1469.85,"setting":"both","billing_class":"facility"}]},{"description":"CT C-SPINE WO/","code_information":[{"code":"19970","type":"CDM"},{"code":"352","type":"RC"},{"code":"72125","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2070.82,"discounted_cash":1035.41,"setting":"both","billing_class":"facility"}]},{"description":"CT C-SPINE W","code_information":[{"code":"19971","type":"CDM"},{"code":"352","type":"RC"},{"code":"72126","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1796.04,"discounted_cash":898.02,"setting":"both","billing_class":"facility"}]},{"description":"CT C-SPINE WO/W","code_information":[{"code":"19972","type":"CDM"},{"code":"352","type":"RC"},{"code":"72127","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2533.18,"discounted_cash":1266.59,"setting":"both","billing_class":"facility"}]},{"description":"CT T-SPINE W/O","code_information":[{"code":"19973","type":"CDM"},{"code":"352","type":"RC"},{"code":"72128","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.07,"discounted_cash":853.03,"setting":"both","billing_class":"facility"}]},{"description":"CT T-SPINE W","code_information":[{"code":"19974","type":"CDM"},{"code":"352","type":"RC"},{"code":"72129","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1889.88,"discounted_cash":944.94,"setting":"both","billing_class":"facility"}]},{"description":"CT T-SPINE WO/W","code_information":[{"code":"19975","type":"CDM"},{"code":"352","type":"RC"},{"code":"72130","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2532.14,"discounted_cash":1266.07,"setting":"both","billing_class":"facility"}]},{"description":"CT L-SPINE WO","code_information":[{"code":"19976","type":"CDM"},{"code":"352","type":"RC"},{"code":"72131","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2216.5,"discounted_cash":1108.25,"setting":"both","billing_class":"facility"}]},{"description":"CT L-SPINE W","code_information":[{"code":"19977","type":"CDM"},{"code":"352","type":"RC"},{"code":"72132","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1787.32,"discounted_cash":893.66,"setting":"both","billing_class":"facility"}]},{"description":"CT L-SPINE WO/W","code_information":[{"code":"19978","type":"CDM"},{"code":"352","type":"RC"},{"code":"72133","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2704.09,"discounted_cash":1352.05,"setting":"both","billing_class":"facility"}]},{"description":"CT PELVIS WO","code_information":[{"code":"19979","type":"CDM"},{"code":"352","type":"RC"},{"code":"72192","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2003.68,"discounted_cash":1001.84,"setting":"both","billing_class":"facility"}]},{"description":"CT PELVIS W","code_information":[{"code":"19980","type":"CDM"},{"code":"352","type":"RC"},{"code":"72193","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1996.11,"discounted_cash":998.05,"setting":"both","billing_class":"facility"}]},{"description":"CT PELVIS WO/W","code_information":[{"code":"19981","type":"CDM"},{"code":"352","type":"RC"},{"code":"72194","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2644.58,"discounted_cash":1322.29,"setting":"both","billing_class":"facility"}]},{"description":"CT UP EXT WO LT","code_information":[{"code":"19982","type":"CDM"},{"code":"352","type":"RC"},{"code":"73200","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1603.45,"discounted_cash":801.73,"setting":"both","billing_class":"facility"}]},{"description":"CT UP EXT WO RT","code_information":[{"code":"19983","type":"CDM"},{"code":"352","type":"RC"},{"code":"73200","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1603.45,"discounted_cash":801.73,"setting":"both","billing_class":"facility"}]},{"description":"CT UP EXT W LT","code_information":[{"code":"19984","type":"CDM"},{"code":"352","type":"RC"},{"code":"73201","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":955.0,"setting":"both","billing_class":"facility"}]},{"description":"CT UP EXT W RT","code_information":[{"code":"19985","type":"CDM"},{"code":"352","type":"RC"},{"code":"73201","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":955.0,"setting":"both","billing_class":"facility"}]},{"description":"CT UP EXT WO/W LT","code_information":[{"code":"19986","type":"CDM"},{"code":"352","type":"RC"},{"code":"73202","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1968.26,"discounted_cash":984.13,"setting":"both","billing_class":"facility"}]},{"description":"CT UP EXT WO/W RT","code_information":[{"code":"19987","type":"CDM"},{"code":"352","type":"RC"},{"code":"73202","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1968.26,"discounted_cash":984.13,"setting":"both","billing_class":"facility"}]},{"description":"CT LOW EXT WO LT","code_information":[{"code":"19988","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.14,"discounted_cash":960.07,"setting":"both","billing_class":"facility"}]},{"description":"CT LOW EXT WO RT","code_information":[{"code":"19989","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.14,"discounted_cash":960.07,"setting":"both","billing_class":"facility"}]},{"description":"CT LOW EXT W LT","code_information":[{"code":"19990","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2058.18,"discounted_cash":1029.09,"setting":"both","billing_class":"facility"}]},{"description":"CT LOW EXT W RT","code_information":[{"code":"19991","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2058.18,"discounted_cash":1029.09,"setting":"both","billing_class":"facility"}]},{"description":"CT LOW EXT WO/W LT","code_information":[{"code":"19992","type":"CDM"},{"code":"352","type":"RC"},{"code":"73702","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1592.27,"discounted_cash":796.13,"setting":"both","billing_class":"facility"}]},{"description":"CT LOW EXT WO/W RT","code_information":[{"code":"19993","type":"CDM"},{"code":"352","type":"RC"},{"code":"73702","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1592.27,"discounted_cash":796.13,"setting":"both","billing_class":"facility"}]},{"description":"CT LOW DOSE LUNG SCR","code_information":[{"code":"19994","type":"CDM"},{"code":"352","type":"RC"},{"code":"71271","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":448.36,"discounted_cash":224.18,"setting":"both","billing_class":"facility"}]},{"description":"CT ABDOMEN WO","code_information":[{"code":"19995","type":"CDM"},{"code":"352","type":"RC"},{"code":"74150","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1830.21,"discounted_cash":915.11,"setting":"both","billing_class":"facility"}]},{"description":"CT ABDOMEN W","code_information":[{"code":"19996","type":"CDM"},{"code":"352","type":"RC"},{"code":"74160","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2151.92,"discounted_cash":1075.96,"setting":"both","billing_class":"facility"}]},{"description":"CT ABDOMEN WO/W","code_information":[{"code":"19997","type":"CDM"},{"code":"352","type":"RC"},{"code":"74170","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2471.06,"discounted_cash":1235.53,"setting":"both","billing_class":"facility"}]},{"description":"CTA ABDOMEN WO/W","code_information":[{"code":"19998","type":"CDM"},{"code":"352","type":"RC"},{"code":"74175","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2605.45,"discounted_cash":1302.72,"setting":"both","billing_class":"facility"}]},{"description":"CT ABD/PELVIS WO","code_information":[{"code":"19999","type":"CDM"},{"code":"352","type":"RC"},{"code":"74176","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2350.73,"discounted_cash":1175.37,"setting":"both","billing_class":"facility"}]},{"description":"PAC G32 RANG 350-400","code_information":[{"code":"2","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1069.0,"discounted_cash":534.5,"setting":"both","billing_class":"facility"}]},{"description":"M/S 2 OBS DIRECT ADM","code_information":[{"code":"20","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0379","type":"HCPCS"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":772.1,"discounted_cash":386.05,"setting":"both","billing_class":"facility"}]},{"description":"CT ABD/PELVIS WO/W","code_information":[{"code":"20000","type":"CDM"},{"code":"352","type":"RC"},{"code":"74178","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3272.84,"discounted_cash":1636.42,"setting":"both","billing_class":"facility"}]},{"description":"RIBS UNIL 2 VWS RT","code_information":[{"code":"20001","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.11,"discounted_cash":147.56,"setting":"both","billing_class":"facility"}]},{"description":"RIBS UNIL 2VWS LT","code_information":[{"code":"20002","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.11,"discounted_cash":147.56,"setting":"both","billing_class":"facility"}]},{"description":"RIB W/CHST 3V UNI RT","code_information":[{"code":"20003","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":335.65,"discounted_cash":167.82,"setting":"both","billing_class":"facility"}]},{"description":"RIB W/CHST 3V UNI LT","code_information":[{"code":"20004","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":335.65,"discounted_cash":167.82,"setting":"both","billing_class":"facility"}]},{"description":"RIBS W/CHST BIL 4VWS","code_information":[{"code":"20005","type":"CDM"},{"code":"320","type":"RC"},{"code":"71111","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":335.65,"discounted_cash":167.82,"setting":"both","billing_class":"facility"}]},{"description":"STERNUM 2/>VWS","code_information":[{"code":"20006","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"STERNOCLAVIC JT 3/>V","code_information":[{"code":"20007","type":"CDM"},{"code":"320","type":"RC"},{"code":"71130","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":230.53,"discounted_cash":115.27,"setting":"both","billing_class":"facility"}]},{"description":"WRIST COMP >3VW LT","code_information":[{"code":"20008","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":338.16,"discounted_cash":169.08,"setting":"both","billing_class":"facility"}]},{"description":"WRIST COMP >3VW RT","code_information":[{"code":"20009","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":338.16,"discounted_cash":169.08,"setting":"both","billing_class":"facility"}]},{"description":"FOREARM 2 VIEW LT","code_information":[{"code":"20011","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":328.03,"discounted_cash":164.01,"setting":"both","billing_class":"facility"}]},{"description":"FOREARM 2 VIEW RT","code_information":[{"code":"20012","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":328.03,"discounted_cash":164.01,"setting":"both","billing_class":"facility"}]},{"description":"THORACIC SPINE 2 VW","code_information":[{"code":"20013","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"LS SPINE 2 OR 3 V","code_information":[{"code":"20014","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"LS SPINE 4VW >","code_information":[{"code":"20015","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":454.68,"discounted_cash":227.34,"setting":"both","billing_class":"facility"}]},{"description":"PELVIS AP ONLY","code_information":[{"code":"20016","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":286.23,"discounted_cash":143.12,"setting":"both","billing_class":"facility"}]},{"description":"SPINE CERVICAL 1 VIE","code_information":[{"code":"20017","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":507.92,"discounted_cash":253.96,"setting":"both","billing_class":"facility"}]},{"description":"SACRUM/COCCYX","code_information":[{"code":"20018","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.61,"discounted_cash":120.31,"setting":"both","billing_class":"facility"}]},{"description":"SI JOINTS >3","code_information":[{"code":"20019","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"CLAVICLE COMPLETE LT","code_information":[{"code":"20020","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.96,"discounted_cash":189.98,"setting":"both","billing_class":"facility"}]},{"description":"CLAVICLE COMPLETE RT","code_information":[{"code":"20021","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.96,"discounted_cash":189.98,"setting":"both","billing_class":"facility"}]},{"description":"SCAPULA COMPLETE LT","code_information":[{"code":"20022","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"SPINE CERVICAL 2-3 V","code_information":[{"code":"20023","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":534.47,"discounted_cash":267.24,"setting":"both","billing_class":"facility"}]},{"description":"SHOULDER COMPLETE LT","code_information":[{"code":"20024","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":474.95,"discounted_cash":237.47,"setting":"both","billing_class":"facility"}]},{"description":"SHOULDER COMPLETE RT","code_information":[{"code":"20025","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":474.95,"discounted_cash":237.47,"setting":"both","billing_class":"facility"}]},{"description":"AC JOINTS","code_information":[{"code":"20027","type":"CDM"},{"code":"320","type":"RC"},{"code":"73050","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":463.51,"discounted_cash":231.75,"setting":"both","billing_class":"facility"}]},{"description":"HUMERUS 2 VIEW LT","code_information":[{"code":"20028","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":273.58,"discounted_cash":136.79,"setting":"both","billing_class":"facility"}]},{"description":"HUMERUS 2 VIEW RT","code_information":[{"code":"20029","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":273.58,"discounted_cash":136.79,"setting":"both","billing_class":"facility"}]},{"description":"ELBOW 3 VIEW LT","code_information":[{"code":"20030","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.96,"discounted_cash":189.98,"setting":"both","billing_class":"facility"}]},{"description":"ELBOW 3 VIEW RT","code_information":[{"code":"20031","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.96,"discounted_cash":189.98,"setting":"both","billing_class":"facility"}]},{"description":"SCAPULA COMPLETE RT","code_information":[{"code":"20032","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"C SPINE 4 OR 5 VIEWS","code_information":[{"code":"20033","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":474.95,"discounted_cash":237.47,"setting":"both","billing_class":"facility"}]},{"description":"HAND 3 VIEW RT","code_information":[{"code":"20034","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":338.16,"discounted_cash":169.08,"setting":"both","billing_class":"facility"}]},{"description":"HAND 3 VIEW LT","code_information":[{"code":"20035","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":338.16,"discounted_cash":169.08,"setting":"both","billing_class":"facility"}]},{"description":"HAND 2 VIEW LT","code_information":[{"code":"20036","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":362.25,"discounted_cash":181.13,"setting":"both","billing_class":"facility"}]},{"description":"HAND 2 VIEW RT","code_information":[{"code":"20037","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":362.25,"discounted_cash":181.13,"setting":"both","billing_class":"facility"}]},{"description":"FINGER 2 VIEW LT","code_information":[{"code":"20038","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"FINGER 2 VIEW RT","code_information":[{"code":"20039","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"C SPINE 6 OR >VIEWS","code_information":[{"code":"20043","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.94,"discounted_cash":389.47,"setting":"both","billing_class":"facility"}]},{"description":"KNEE 1-2 VIEW LT","code_information":[{"code":"20046","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":469.88,"discounted_cash":234.94,"setting":"both","billing_class":"facility"}]},{"description":"KNEE 1-2 VIEW RT","code_information":[{"code":"20047","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":469.88,"discounted_cash":234.94,"setting":"both","billing_class":"facility"}]},{"description":"KNEE 3 VIEW LT","code_information":[{"code":"20048","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":716.87,"discounted_cash":358.44,"setting":"both","billing_class":"facility"}]},{"description":"KNEE 3 VIEW RT","code_information":[{"code":"20049","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":716.87,"discounted_cash":358.44,"setting":"both","billing_class":"facility"}]},{"description":"KNEE COMPLT >4 VIW L","code_information":[{"code":"20050","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"KNEE COMPLT >4 VEW R","code_information":[{"code":"20051","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"TIBIA FIBLA 2 VEW LT","code_information":[{"code":"20052","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":357.13,"discounted_cash":178.56,"setting":"both","billing_class":"facility"}]},{"description":"TIBIA FIBLA 2 VEW RT","code_information":[{"code":"20053","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":357.13,"discounted_cash":178.56,"setting":"both","billing_class":"facility"}]},{"description":"ANKLE COMPLT 3 VW LT","code_information":[{"code":"20054","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":360.94,"discounted_cash":180.47,"setting":"both","billing_class":"facility"}]},{"description":"ANKLE COMPLT 3 VW RT","code_information":[{"code":"20055","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":360.94,"discounted_cash":180.47,"setting":"both","billing_class":"facility"}]},{"description":"FOOT COMPLETE >3 LT","code_information":[{"code":"20056","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":355.87,"discounted_cash":177.94,"setting":"both","billing_class":"facility"}]},{"description":"FOOT COMPLETE >3 RT","code_information":[{"code":"20057","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":355.87,"discounted_cash":177.94,"setting":"both","billing_class":"facility"}]},{"description":"HEEL/CALCNEOS 2 VW L","code_information":[{"code":"20058","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":367.32,"discounted_cash":183.66,"setting":"both","billing_class":"facility"}]},{"description":"HEEL/CALCANOS 2 VW R","code_information":[{"code":"20059","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":367.32,"discounted_cash":183.66,"setting":"both","billing_class":"facility"}]},{"description":"TOE 2 VIEW LT","code_information":[{"code":"20060","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"TOE 2 VIEW RT","code_information":[{"code":"20061","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"ELBOW 2 VIEW LT","code_information":[{"code":"20062","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"ELBOW 2 VIEW RT","code_information":[{"code":"20063","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"WRIST 2 VIEW LT","code_information":[{"code":"20064","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":279.9,"discounted_cash":139.95,"setting":"both","billing_class":"facility"}]},{"description":"WRIST 2 VIEW RT","code_information":[{"code":"20065","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":279.9,"discounted_cash":139.95,"setting":"both","billing_class":"facility"}]},{"description":"KNEE STANDNG BILATEL","code_information":[{"code":"20068","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":366.06,"discounted_cash":183.03,"setting":"both","billing_class":"facility"}]},{"description":"INFAT LWR EXT 2 VW R","code_information":[{"code":"20069","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"INFAT LWR EXT 2 VW L","code_information":[{"code":"20070","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"ABD COMP ACUTE SERIE","code_information":[{"code":"20073","type":"CDM"},{"code":"320","type":"RC"},{"code":"74022","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.96,"discounted_cash":189.98,"setting":"both","billing_class":"facility"}]},{"description":"IVP W TOMOGRAPHY","code_information":[{"code":"20074","type":"CDM"},{"code":"320","type":"RC"},{"code":"74400","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":858.36,"discounted_cash":429.18,"setting":"both","billing_class":"facility"}]},{"description":"ANKLE 2 VIEW LT","code_information":[{"code":"20075","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":284.97,"discounted_cash":142.49,"setting":"both","billing_class":"facility"}]},{"description":"ANKLE 2 VIEW RT","code_information":[{"code":"20076","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":284.97,"discounted_cash":142.49,"setting":"both","billing_class":"facility"}]},{"description":"FOOT 2 VIEW LT","code_information":[{"code":"20077","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":305.24,"discounted_cash":152.62,"setting":"both","billing_class":"facility"}]},{"description":"FOOT 2 VIEW RT","code_information":[{"code":"20078","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":305.24,"discounted_cash":152.62,"setting":"both","billing_class":"facility"}]},{"description":"SCOLIOSIS COMPLETE","code_information":[{"code":"20079","type":"CDM"},{"code":"320","type":"RC"},{"code":"72084","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":398.98,"discounted_cash":199.49,"setting":"both","billing_class":"facility"}]},{"description":"SCOLIOSIS EVAL 2-3 V","code_information":[{"code":"20080","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"HIP LT 2-3","code_information":[{"code":"20081","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"HIP RT 2-3","code_information":[{"code":"20082","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"HIP LT 4+ VIEWS","code_information":[{"code":"20083","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"HIP RT 4+ VIEWS","code_information":[{"code":"20084","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"BILAT HIPS W/PEL 2VW","code_information":[{"code":"20085","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":263.44,"discounted_cash":131.72,"setting":"both","billing_class":"facility"}]},{"description":"BILAT HIPS W/ PEL3-4","code_information":[{"code":"20086","type":"CDM"},{"code":"320","type":"RC"},{"code":"73522","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":263.44,"discounted_cash":131.72,"setting":"both","billing_class":"facility"}]},{"description":"BILAT HIPS W/ PEL 5+","code_information":[{"code":"20087","type":"CDM"},{"code":"320","type":"RC"},{"code":"73523","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":474.95,"discounted_cash":237.47,"setting":"both","billing_class":"facility"}]},{"description":"FEMUR LT 1 VIEW","code_information":[{"code":"20088","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.32,"discounted_cash":79.16,"setting":"both","billing_class":"facility"}]},{"description":"FEMUR RT 1 VIEW","code_information":[{"code":"20089","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.32,"discounted_cash":79.16,"setting":"both","billing_class":"facility"}]},{"description":"FEMUR LT 2+ VIEWS","code_information":[{"code":"20090","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.32,"discounted_cash":79.16,"setting":"both","billing_class":"facility"}]},{"description":"FEMUR RT 2+ VIEWS","code_information":[{"code":"20091","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.32,"discounted_cash":79.16,"setting":"both","billing_class":"facility"}]},{"description":"HIP LT 1 VIEW","code_information":[{"code":"20092","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"HIP RT 1 VIEW","code_information":[{"code":"20093","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.32,"discounted_cash":79.16,"setting":"both","billing_class":"facility"}]},{"description":"SPINE LUMBR CMP W BD","code_information":[{"code":"20094","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":618.07,"discounted_cash":309.04,"setting":"both","billing_class":"facility"}]},{"description":"PELVIS COMP > 3","code_information":[{"code":"20095","type":"CDM"},{"code":"320","type":"RC"},{"code":"72190","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.25,"discounted_cash":105.13,"setting":"both","billing_class":"facility"}]},{"description":"SI JOINTS <3","code_information":[{"code":"20096","type":"CDM"},{"code":"320","type":"RC"},{"code":"72200","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"EYE FOR FOREIGN BODY","code_information":[{"code":"20097","type":"CDM"},{"code":"320","type":"RC"},{"code":"70030","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":208.95,"discounted_cash":104.47,"setting":"both","billing_class":"facility"}]},{"description":"MANDIBLE COMPLT 4 VW","code_information":[{"code":"20098","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":353.37,"discounted_cash":176.69,"setting":"both","billing_class":"facility"}]},{"description":"MASTOIDS COMPLETE","code_information":[{"code":"20099","type":"CDM"},{"code":"320","type":"RC"},{"code":"70130","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"FACIAL BONES COMPLET","code_information":[{"code":"20100","type":"CDM"},{"code":"320","type":"RC"},{"code":"70150","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.99,"discounted_cash":152.0,"setting":"both","billing_class":"facility"}]},{"description":"NASAL BONES COMPLETE","code_information":[{"code":"20101","type":"CDM"},{"code":"320","type":"RC"},{"code":"70160","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"ORBITS COMPLETE","code_information":[{"code":"20102","type":"CDM"},{"code":"320","type":"RC"},{"code":"70200","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":344.48,"discounted_cash":172.24,"setting":"both","billing_class":"facility"}]},{"description":"SINUS 1 OR 2 VIEW","code_information":[{"code":"20103","type":"CDM"},{"code":"320","type":"RC"},{"code":"70210","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":272.27,"discounted_cash":136.13,"setting":"both","billing_class":"facility"}]},{"description":"SINUS PARA COMPLETE","code_information":[{"code":"20104","type":"CDM"},{"code":"320","type":"RC"},{"code":"70220","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":433.15,"discounted_cash":216.57,"setting":"both","billing_class":"facility"}]},{"description":"SKULL <4","code_information":[{"code":"20105","type":"CDM"},{"code":"320","type":"RC"},{"code":"70250","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"SKULL COMPLETE","code_information":[{"code":"20106","type":"CDM"},{"code":"320","type":"RC"},{"code":"70260","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":428.29,"discounted_cash":214.15,"setting":"both","billing_class":"facility"}]},{"description":"TMJ LT","code_information":[{"code":"20107","type":"CDM"},{"code":"320","type":"RC"},{"code":"70328","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":347.04,"discounted_cash":173.52,"setting":"both","billing_class":"facility"}]},{"description":"TMJ RT","code_information":[{"code":"20108","type":"CDM"},{"code":"320","type":"RC"},{"code":"70328","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":347.04,"discounted_cash":173.52,"setting":"both","billing_class":"facility"}]},{"description":"TMJ BILATERAL","code_information":[{"code":"20109","type":"CDM"},{"code":"320","type":"RC"},{"code":"70330","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":577.52,"discounted_cash":288.76,"setting":"both","billing_class":"facility"}]},{"description":"NECK SOFT TISSUE","code_information":[{"code":"20110","type":"CDM"},{"code":"320","type":"RC"},{"code":"70360","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":310.31,"discounted_cash":155.16,"setting":"both","billing_class":"facility"}]},{"description":"XR THORACOLUMBAR","code_information":[{"code":"20111","type":"CDM"},{"code":"320","type":"RC"},{"code":"72080","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.44,"discounted_cash":128.22,"setting":"both","billing_class":"facility"}]},{"description":"BONE LENGTH STUDY","code_information":[{"code":"20115","type":"CDM"},{"code":"320","type":"RC"},{"code":"77073","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"BONE SURVEY LTD","code_information":[{"code":"20116","type":"CDM"},{"code":"320","type":"RC"},{"code":"77074","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"BONE SURVEY COMPLETE","code_information":[{"code":"20117","type":"CDM"},{"code":"320","type":"RC"},{"code":"77075","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.3,"discounted_cash":174.15,"setting":"both","billing_class":"facility"}]},{"description":"KNEE 4 >VWS BOTH L R","code_information":[{"code":"20119","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":951.21,"discounted_cash":475.61,"setting":"both","billing_class":"facility"}]},{"description":"MR LOW EXT JT WO BLT","code_information":[{"code":"20120","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":3809.23,"discounted_cash":1904.62,"setting":"both","billing_class":"facility"}]},{"description":"LOCM 300-399MG 1 ML","code_information":[{"code":"20121","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.34,"setting":"both","billing_class":"facility"}]},{"description":"CHEST 1 VIEW","code_information":[{"code":"20122","type":"CDM"},{"code":"324","type":"RC"},{"code":"71045","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":208.95,"discounted_cash":104.47,"setting":"both","billing_class":"facility"}]},{"description":"CHEST 2 VIEWS","code_information":[{"code":"20123","type":"CDM"},{"code":"324","type":"RC"},{"code":"71046","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":379.96,"discounted_cash":189.98,"setting":"both","billing_class":"facility"}]},{"description":"CHEST 3 VW F&L LORDO","code_information":[{"code":"20124","type":"CDM"},{"code":"324","type":"RC"},{"code":"71047","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.44,"discounted_cash":113.72,"setting":"both","billing_class":"facility"}]},{"description":"CHEST 4/>VIEWS","code_information":[{"code":"20125","type":"CDM"},{"code":"324","type":"RC"},{"code":"71048","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":436.97,"discounted_cash":218.49,"setting":"both","billing_class":"facility"}]},{"description":"ABDOMEN KUB 1 VW","code_information":[{"code":"20126","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":293.85,"discounted_cash":146.93,"setting":"both","billing_class":"facility"}]},{"description":"ABDOMEN FLAT&UPRIGHT","code_information":[{"code":"20127","type":"CDM"},{"code":"320","type":"RC"},{"code":"74019","type":"CPT"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":265.95,"discounted_cash":132.97,"setting":"both","billing_class":"facility"}]},{"description":"INJ GAD CTRST P 1ML","code_information":[{"code":"20128","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9579","type":"HCPCS"},{"code":"671","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":5.46,"setting":"both","billing_class":"facility"}]},{"description":"ER VISIT LEV1","code_information":[{"code":"20917","type":"CDM"},{"code":"450","type":"RC"},{"code":"99281","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":356.24,"discounted_cash":178.12,"setting":"both","billing_class":"facility"}]},{"description":"ER VISIT LEV2","code_information":[{"code":"20918","type":"CDM"},{"code":"450","type":"RC"},{"code":"99282","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":612.25,"discounted_cash":306.13,"setting":"both","billing_class":"facility"}]},{"description":"ER VISIT LEV3","code_information":[{"code":"20919","type":"CDM"},{"code":"450","type":"RC"},{"code":"99283","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":1226.11,"discounted_cash":613.05,"setting":"both","billing_class":"facility"}]},{"description":"ER VISIT LEV4","code_information":[{"code":"20920","type":"CDM"},{"code":"450","type":"RC"},{"code":"99284","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":1834.59,"discounted_cash":917.29,"setting":"both","billing_class":"facility"}]},{"description":"ER VISIT LEV5","code_information":[{"code":"20921","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":2431.48,"discounted_cash":1215.74,"setting":"both","billing_class":"facility"}]},{"description":"ER CRIT CARE","code_information":[{"code":"20922","type":"CDM"},{"code":"450","type":"RC"},{"code":"99291","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":5811.77,"discounted_cash":2905.89,"setting":"both","billing_class":"facility"}]},{"description":"ER INPATIENT HOLD","code_information":[{"code":"20924","type":"CDM"},{"code":"110","type":"RC"},{"code":"99292","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":2028.39,"discounted_cash":1014.2,"setting":"both","billing_class":"facility"}]},{"description":"ER PROCEDURE LVL 1","code_information":[{"code":"20928","type":"CDM"},{"code":"450","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":273.06,"discounted_cash":136.53,"setting":"both","billing_class":"facility"}]},{"description":"ER PROCEDURE LVL 2","code_information":[{"code":"20929","type":"CDM"},{"code":"450","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":382.95,"discounted_cash":191.47,"setting":"both","billing_class":"facility"}]},{"description":"ER PROCEDURE LVL 3","code_information":[{"code":"20930","type":"CDM"},{"code":"450","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":1282.47,"discounted_cash":641.24,"setting":"both","billing_class":"facility"}]},{"description":"ER OBS 1ST HR","code_information":[{"code":"20931","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":620.63,"discounted_cash":310.31,"setting":"both","billing_class":"facility"}]},{"description":"ER OBS ADD HRS","code_information":[{"code":"20932","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.1,"discounted_cash":54.55,"setting":"both","billing_class":"facility"}]},{"description":"IV INF HYDR 1ST HR","code_information":[{"code":"20933","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":294.1,"discounted_cash":147.05,"setting":"both","billing_class":"facility"}]},{"description":"IV INF HYDR ADDL HR","code_information":[{"code":"20934","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.3,"discounted_cash":26.65,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX 1HR","code_information":[{"code":"20935","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":294.1,"discounted_cash":147.05,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX ADDL HR","code_information":[{"code":"20936","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX SEQ 1HR","code_information":[{"code":"20937","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":166.1,"discounted_cash":83.05,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX CONCRNT","code_information":[{"code":"20938","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.15,"discounted_cash":47.58,"setting":"both","billing_class":"facility"}]},{"description":"TEMP TRANS PACE","code_information":[{"code":"20939","type":"CDM"},{"code":"450","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":18856.6,"discounted_cash":9428.3,"setting":"both","billing_class":"facility"}]},{"description":"INJECTION IM/SQ","code_information":[{"code":"20940","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.5,"discounted_cash":79.25,"setting":"both","billing_class":"facility"}]},{"description":"INJ IV SGL/INT SUB","code_information":[{"code":"20941","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":361.35,"discounted_cash":180.68,"setting":"both","billing_class":"facility"}]},{"description":"INJ IV ADD/SEQ SUBS","code_information":[{"code":"20942","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.5,"discounted_cash":79.25,"setting":"both","billing_class":"facility"}]},{"description":"IV INJ SAME DRUG ADD","code_information":[{"code":"20943","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":183.8,"discounted_cash":91.9,"setting":"both","billing_class":"facility"}]},{"description":"CASIRIVI IMDEVI INF","code_information":[{"code":"20945","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0243","type":"HCPCS"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":1081.52,"discounted_cash":540.76,"setting":"both","billing_class":"facility"}]},{"description":"SOTROVIMAB INFUSION","code_information":[{"code":"20946","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0247","type":"HCPCS"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":1132.31,"discounted_cash":566.15,"setting":"both","billing_class":"facility"}]},{"description":"PULSE OXIMETRY ER","code_information":[{"code":"20947","type":"CDM"},{"code":"460","type":"RC"},{"code":"94762","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":330.53,"discounted_cash":165.26,"setting":"both","billing_class":"facility"}]},{"description":"CPR","code_information":[{"code":"20948","type":"CDM"},{"code":"450","type":"RC"},{"code":"92950","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":1150.01,"discounted_cash":575.0,"setting":"both","billing_class":"facility"}]},{"description":"CARDIOVERSION/DEFIB","code_information":[{"code":"20950","type":"CDM"},{"code":"450","type":"RC"},{"code":"92960","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.81,"discounted_cash":895.9,"setting":"both","billing_class":"facility"}]},{"description":"EEG 41-60 MINUTES","code_information":[{"code":"20951","type":"CDM"},{"code":"740","type":"RC"},{"code":"95812","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":968.3,"discounted_cash":484.15,"setting":"both","billing_class":"facility"}]},{"description":"EEG AWAKE DRWSY 20-4","code_information":[{"code":"20952","type":"CDM"},{"code":"740","type":"RC"},{"code":"95816","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":968.3,"discounted_cash":484.15,"setting":"both","billing_class":"facility"}]},{"description":"EEG AWAKE &ASLEEP 20","code_information":[{"code":"20953","type":"CDM"},{"code":"740","type":"RC"},{"code":"95819","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":968.3,"discounted_cash":484.15,"setting":"both","billing_class":"facility"}]},{"description":"EEG EXTND MNTR 61-11","code_information":[{"code":"20954","type":"CDM"},{"code":"740","type":"RC"},{"code":"95813","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":968.3,"discounted_cash":484.15,"setting":"both","billing_class":"facility"}]},{"description":"EEG W/O VID 2-12HR","code_information":[{"code":"20955","type":"CDM"},{"code":"740","type":"RC"},{"code":"95707","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":994.84,"discounted_cash":497.42,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD ADMINISTRATION","code_information":[{"code":"20960","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":935.38,"discounted_cash":467.69,"setting":"both","billing_class":"facility"}]},{"description":"ARTERIAL PUNCTURE ER","code_information":[{"code":"20962","type":"CDM"},{"code":"450","type":"RC"},{"code":"36600","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":277.13,"discounted_cash":138.56,"setting":"both","billing_class":"facility"}]},{"description":"CATH UA COLLECTION","code_information":[{"code":"20963","type":"CDM"},{"code":"450","type":"RC"},{"code":"P9612","type":"HCPCS"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.62,"discounted_cash":17.81,"setting":"both","billing_class":"facility"}]},{"description":"UA DIPSTICK","code_information":[{"code":"20967","type":"CDM"},{"code":"300","type":"RC"},{"code":"81003","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.05,"discounted_cash":4.03,"setting":"both","billing_class":"facility"}]},{"description":"GLUCOMETER ER","code_information":[{"code":"20968","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.6,"discounted_cash":10.3,"setting":"both","billing_class":"facility"}]},{"description":"URINE PREGNANCY TST","code_information":[{"code":"20969","type":"CDM"},{"code":"300","type":"RC"},{"code":"81025","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":97.3,"discounted_cash":48.65,"setting":"both","billing_class":"facility"}]},{"description":"IMMUN ADMIN 1ST VACC","code_information":[{"code":"20970","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":99.43,"discounted_cash":49.72,"setting":"both","billing_class":"facility"}]},{"description":"IMMUN ADMIN ADD VACC","code_information":[{"code":"20971","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.35,"discounted_cash":23.18,"setting":"both","billing_class":"facility"}]},{"description":"MOD SED >5YR 1ST 30M","code_information":[{"code":"20972","type":"CDM"},{"code":"450","type":"RC"},{"code":"99152","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":340.69,"discounted_cash":170.34,"setting":"both","billing_class":"facility"}]},{"description":"MOD SED <5YR 1ST 30M","code_information":[{"code":"20973","type":"CDM"},{"code":"450","type":"RC"},{"code":"99151","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":651.72,"discounted_cash":325.86,"setting":"both","billing_class":"facility"}]},{"description":"VENIPUNCTURE","code_information":[{"code":"20975","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.65,"discounted_cash":15.32,"setting":"both","billing_class":"facility"}]},{"description":"TIXAGEV CILGAV INJ","code_information":[{"code":"20983","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0220","type":"HCPCS"},{"code":"670","type":"LOCAL"}],"standard_charges":[{"gross_charge":441.51,"discounted_cash":220.75,"setting":"both","billing_class":"facility"}]},{"description":"THORACENTESIS","code_information":[{"code":"21014","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.37,"discounted_cash":573.18,"setting":"both","billing_class":"facility"}]},{"description":"PARACENTESIS","code_information":[{"code":"21016","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1162.35,"discounted_cash":581.17,"setting":"both","billing_class":"facility"}]},{"description":"THORACOSTOMY W/TUBE","code_information":[{"code":"21017","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.55,"discounted_cash":632.27,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN BL W/CATH INSR","code_information":[{"code":"21018","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":3000.46,"discounted_cash":1500.23,"setting":"both","billing_class":"facility"}]},{"description":"DRN/INJ JOINT","code_information":[{"code":"21024","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":606.57,"discounted_cash":303.29,"setting":"both","billing_class":"facility"}]},{"description":"DECLOT BY THROMB AGT","code_information":[{"code":"21028","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":553.69,"discounted_cash":276.85,"setting":"both","billing_class":"facility"}]},{"description":"CHANGE GASTRO TUBE","code_information":[{"code":"21029","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.74,"discounted_cash":669.87,"setting":"both","billing_class":"facility"}]},{"description":"RPS/RMV GASTRO TUBE","code_information":[{"code":"21030","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":889.87,"discounted_cash":444.94,"setting":"both","billing_class":"facility"}]},{"description":"CHANGE PEG BUTTON","code_information":[{"code":"21031","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":739.44,"discounted_cash":369.72,"setting":"both","billing_class":"facility"}]},{"description":"JOINT MANIPULATION","code_information":[{"code":"21032","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":2321.89,"discounted_cash":1160.94,"setting":"both","billing_class":"facility"}]},{"description":"COLLECT BLOOD VAD","code_information":[{"code":"21050","type":"CDM"},{"code":"300","type":"RC"},{"code":"36600","type":"CPT"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":145.8,"discounted_cash":72.9,"setting":"both","billing_class":"facility"}]},{"description":"VENIPUNCTURE","code_information":[{"code":"21051","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.65,"discounted_cash":19.32,"setting":"both","billing_class":"facility"}]},{"description":"EPIDURAL STEROID INJ","code_information":[{"code":"21052","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.6,"discounted_cash":726.8,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD ADMIN","code_information":[{"code":"21057","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.21,"discounted_cash":447.11,"setting":"both","billing_class":"facility"}]},{"description":"INSERT URINARY CATH","code_information":[{"code":"21061","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.08,"discounted_cash":41.04,"setting":"both","billing_class":"facility"}]},{"description":"CHG SUPRAPUBIC CATH","code_information":[{"code":"21063","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.05,"discounted_cash":187.53,"setting":"both","billing_class":"facility"}]},{"description":"CYSTOSCOPY","code_information":[{"code":"21064","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1474.65,"discounted_cash":737.33,"setting":"both","billing_class":"facility"}]},{"description":"BLADDER SCAN","code_information":[{"code":"21065","type":"CDM"},{"code":"761","type":"RC"},{"code":"51798","type":"CPT"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":275.55,"discounted_cash":137.78,"setting":"both","billing_class":"facility"}]},{"description":"INSTLL CHEMO BLADDER","code_information":[{"code":"21066","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":622.35,"discounted_cash":311.18,"setting":"both","billing_class":"facility"}]},{"description":"INJ EPI BLD/CLOT PAT","code_information":[{"code":"21073","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1268.73,"discounted_cash":634.37,"setting":"both","billing_class":"facility"}]},{"description":"LOW LEVEL OP PROC","code_information":[{"code":"21082","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.05,"discounted_cash":151.53,"setting":"both","billing_class":"facility"}]},{"description":"LVL 3 EST O/P VISIT","code_information":[{"code":"21083","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"438","type":"LOCAL"}],"standard_charges":[{"gross_charge":230.25,"discounted_cash":115.13,"setting":"both","billing_class":"facility"}]},{"description":"IP HEMODIALYSIS","code_information":[{"code":"21086","type":"CDM"},{"code":"801","type":"RC"},{"code":"90935","type":"CPT"},{"code":"537","type":"LOCAL"}],"standard_charges":[{"gross_charge":993.74,"discounted_cash":496.87,"setting":"both","billing_class":"facility"}]},{"description":"OP DIALYSIS UNSCH/EM","code_information":[{"code":"21088","type":"CDM"},{"code":"829","type":"RC"},{"code":"G0257","type":"HCPCS"},{"code":"537","type":"LOCAL"}],"standard_charges":[{"gross_charge":1831.68,"discounted_cash":915.84,"setting":"both","billing_class":"facility"}]},{"description":"IP DIALYSIS CAPD","code_information":[{"code":"21089","type":"CDM"},{"code":"803","type":"RC"},{"code":"90945","type":"CPT"},{"code":"537","type":"LOCAL"}],"standard_charges":[{"gross_charge":1156.4,"discounted_cash":578.2,"setting":"both","billing_class":"facility"}]},{"description":"IP DIALYSIS CCPD","code_information":[{"code":"21090","type":"CDM"},{"code":"804","type":"RC"},{"code":"90945","type":"CPT"},{"code":"537","type":"LOCAL"}],"standard_charges":[{"gross_charge":1209.59,"discounted_cash":604.79,"setting":"both","billing_class":"facility"}]},{"description":"CREATININE BLOOD","code_information":[{"code":"21320","type":"CDM"},{"code":"300","type":"RC"},{"code":"82565","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.1,"discounted_cash":14.55,"setting":"both","billing_class":"facility"}]},{"description":"US TRANSVAGINAL","code_information":[{"code":"21346","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1155.14,"discounted_cash":577.57,"setting":"both","billing_class":"facility"}]},{"description":"US OB TRANSVAGINAL","code_information":[{"code":"21348","type":"CDM"},{"code":"402","type":"RC"},{"code":"76817","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":462.26,"discounted_cash":231.13,"setting":"both","billing_class":"facility"}]},{"description":"LOCM 300-399MG 1ML","code_information":[{"code":"21367","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.34,"setting":"both","billing_class":"facility"}]},{"description":"APPLIGRAF PER SQ CM","code_information":[{"code":"21375","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4101","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":92.46,"discounted_cash":46.23,"setting":"both","billing_class":"facility"}]},{"description":"RMVL IMPLANT DEEP","code_information":[{"code":"21376","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":4232.04,"discounted_cash":2116.02,"setting":"both","billing_class":"facility"}]},{"description":"RMVL IMP SUPERFICIAL","code_information":[{"code":"21377","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":4427.09,"discounted_cash":2213.55,"setting":"both","billing_class":"facility"}]},{"description":"I & D ABSCESS, SIMPL","code_information":[{"code":"21378","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":364.34,"discounted_cash":182.17,"setting":"both","billing_class":"facility"}]},{"description":"AMPUTN TOE-META JNT","code_information":[{"code":"21379","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2825.99,"discounted_cash":1412.99,"setting":"both","billing_class":"facility"}]},{"description":"PREMALIG CUTANS VASC","code_information":[{"code":"21380","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1047.93,"discounted_cash":523.97,"setting":"both","billing_class":"facility"}]},{"description":"AMPUTATION JOINT","code_information":[{"code":"21381","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":7849.88,"discounted_cash":3924.94,"setting":"both","billing_class":"facility"}]},{"description":"I&D ABCESS CMP/MULTI","code_information":[{"code":"21382","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":608.14,"discounted_cash":304.07,"setting":"both","billing_class":"facility"}]},{"description":"DRAIN HEMATOMA/FLUID","code_information":[{"code":"21383","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":3525.2,"discounted_cash":1762.6,"setting":"both","billing_class":"facility"}]},{"description":"DEB SQ TISS 20CM/<","code_information":[{"code":"21384","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":596.17,"discounted_cash":298.08,"setting":"both","billing_class":"facility"}]},{"description":"DEB MSC/FACIA 20CM/<","code_information":[{"code":"21385","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1258.65,"discounted_cash":629.33,"setting":"both","billing_class":"facility"}]},{"description":"DEB BONE 20SQ CM/<","code_information":[{"code":"21386","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2318.59,"discounted_cash":1159.3,"setting":"both","billing_class":"facility"}]},{"description":"DEB SQ TISS ADD-ON","code_information":[{"code":"21387","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":516.7,"discounted_cash":258.35,"setting":"both","billing_class":"facility"}]},{"description":"DEB MSC/FASCA ADD-ON","code_information":[{"code":"21388","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":496.85,"discounted_cash":248.43,"setting":"both","billing_class":"facility"}]},{"description":"DEB BONE ADD-ON","code_information":[{"code":"21389","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1519.9,"discounted_cash":759.95,"setting":"both","billing_class":"facility"}]},{"description":"BIOPSY SKIN LES TISS","code_information":[{"code":"21390","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":596.17,"discounted_cash":298.08,"setting":"both","billing_class":"facility"}]},{"description":"BIOPSY ADDL SEP LES","code_information":[{"code":"21391","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":324.63,"discounted_cash":162.31,"setting":"both","billing_class":"facility"}]},{"description":"ASPIRATION PUNCTURE","code_information":[{"code":"21392","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":576.79,"discounted_cash":288.39,"setting":"both","billing_class":"facility"}]},{"description":"EP LES .6-1 CM SC/NC","code_information":[{"code":"21393","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":258.38,"discounted_cash":129.19,"setting":"both","billing_class":"facility"}]},{"description":"EXC BGN LESION 2.1-3","code_information":[{"code":"21394","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.06,"discounted_cash":853.53,"setting":"both","billing_class":"facility"}]},{"description":"DRS/DBRD P-THCK BRN","code_information":[{"code":"21395","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":431.9,"discounted_cash":215.95,"setting":"both","billing_class":"facility"}]},{"description":"REPAIR WNDS 2.6-7.5C","code_information":[{"code":"21396","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1019.29,"discounted_cash":509.64,"setting":"both","billing_class":"facility"}]},{"description":"INTL TX 1ST DEG BURN","code_information":[{"code":"21397","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":641.84,"discounted_cash":320.92,"setting":"both","billing_class":"facility"}]},{"description":"DEBRI BURN NO ANES M","code_information":[{"code":"21398","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":641.84,"discounted_cash":320.92,"setting":"both","billing_class":"facility"}]},{"description":"DEBRI BURN NO ANES L","code_information":[{"code":"21399","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1082.62,"discounted_cash":541.31,"setting":"both","billing_class":"facility"}]},{"description":"LVL 1 NEW O/P VISIT","code_information":[{"code":"21400","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":164.64,"discounted_cash":82.32,"setting":"both","billing_class":"facility"}]},{"description":"ESCHAROTOMY 1* BURN","code_information":[{"code":"21401","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1082.62,"discounted_cash":541.31,"setting":"both","billing_class":"facility"}]},{"description":"NEGATIVE PRESSURE<50","code_information":[{"code":"21402","type":"CDM"},{"code":"761","type":"RC"},{"code":"97607","type":"CPT"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility"}]},{"description":"NEGATIVE PRESSURE>50","code_information":[{"code":"21403","type":"CDM"},{"code":"761","type":"RC"},{"code":"97608","type":"CPT"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility"}]},{"description":"WOUND SUCTION WDRESS","code_information":[{"code":"21404","type":"CDM"},{"code":"272","type":"RC"},{"code":"A9272","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.05,"discounted_cash":151.53,"setting":"both","billing_class":"facility"}]},{"description":"EX BEN LES 0.6-1.0CM","code_information":[{"code":"21405","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1047.77,"discounted_cash":523.88,"setting":"both","billing_class":"facility"}]},{"description":"EX BEN LES 1.1-2.0CM","code_information":[{"code":"21406","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1818.82,"discounted_cash":909.41,"setting":"both","billing_class":"facility"}]},{"description":"EX BEN LES >4CM","code_information":[{"code":"21407","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":3683.21,"discounted_cash":1841.61,"setting":"both","billing_class":"facility"}]},{"description":"REMOVAL FOREIGN BODY","code_information":[{"code":"21408","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":3732.48,"discounted_cash":1866.24,"setting":"both","billing_class":"facility"}]},{"description":"LVL 2 NEW O/P VISIT","code_information":[{"code":"21409","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":211.98,"discounted_cash":105.99,"setting":"both","billing_class":"facility"}]},{"description":"LVL 3 NEW O/P VISIT","code_information":[{"code":"21410","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":251.74,"discounted_cash":125.87,"setting":"both","billing_class":"facility"}]},{"description":"LVL 4 NEW O/P VISIT","code_information":[{"code":"21411","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":278.18,"discounted_cash":139.09,"setting":"both","billing_class":"facility"}]},{"description":"LVL 5 NEW O/P VISIT","code_information":[{"code":"21412","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":317.99,"discounted_cash":159.0,"setting":"both","billing_class":"facility"}]},{"description":"LVL 1 EST O/P VISIT","code_information":[{"code":"21413","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":172.27,"discounted_cash":86.14,"setting":"both","billing_class":"facility"}]},{"description":"LVL 2 EST O/P VISIT","code_information":[{"code":"21414","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":211.98,"discounted_cash":105.99,"setting":"both","billing_class":"facility"}]},{"description":"LVL 3 EST O/P VISIT","code_information":[{"code":"21415","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":251.74,"discounted_cash":125.87,"setting":"both","billing_class":"facility"}]},{"description":"LVL 4 EST O/P VISIT","code_information":[{"code":"21416","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":278.18,"discounted_cash":139.09,"setting":"both","billing_class":"facility"}]},{"description":"LVL 5 EST O/P VISIT","code_information":[{"code":"21417","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":317.99,"discounted_cash":159.0,"setting":"both","billing_class":"facility"}]},{"description":"APPL UNNA BOOT RT","code_information":[{"code":"21420","type":"CDM"},{"code":"361","type":"RC"},{"code":"29580","type":"CPT"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":278.18,"discounted_cash":139.09,"setting":"both","billing_class":"facility"}]},{"description":"APPL UNNA BOOT LT","code_information":[{"code":"21421","type":"CDM"},{"code":"361","type":"RC"},{"code":"29580","type":"CPT"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":278.18,"discounted_cash":139.09,"setting":"both","billing_class":"facility"}]},{"description":"APPL UNNA BOOT BILAT","code_information":[{"code":"21422","type":"CDM"},{"code":"361","type":"RC"},{"code":"29580","type":"CPT"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":406.77,"discounted_cash":203.38,"setting":"both","billing_class":"facility"}]},{"description":"CAUTERY 1ST LESION","code_information":[{"code":"21425","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":305.24,"discounted_cash":152.62,"setting":"both","billing_class":"facility"}]},{"description":"CAUTERY 2-14 LESION","code_information":[{"code":"21426","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.35,"discounted_cash":41.17,"setting":"both","billing_class":"facility"}]},{"description":"CAUTERIZATION CHEM","code_information":[{"code":"21427","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":340.51,"discounted_cash":170.25,"setting":"both","billing_class":"facility"}]},{"description":"APP CAST TOTAL CNTCT","code_information":[{"code":"21428","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":649.21,"discounted_cash":324.61,"setting":"both","billing_class":"facility"}]},{"description":"STRAPPING SHOULDER","code_information":[{"code":"21429","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":510.43,"discounted_cash":255.22,"setting":"both","billing_class":"facility"}]},{"description":"STRAPPING ELBW/WRIST","code_information":[{"code":"21430","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":323.11,"discounted_cash":161.56,"setting":"both","billing_class":"facility"}]},{"description":"NEG PRES WND TX <50","code_information":[{"code":"21431","type":"CDM"},{"code":"761","type":"RC"},{"code":"97605","type":"CPT"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":353.75,"discounted_cash":176.88,"setting":"both","billing_class":"facility"}]},{"description":"NEG PRES WND TX >50","code_information":[{"code":"21432","type":"CDM"},{"code":"361","type":"RC"},{"code":"97606","type":"CPT"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":369.67,"discounted_cash":184.84,"setting":"both","billing_class":"facility"}]},{"description":"ACTIVE WND CARE /20","code_information":[{"code":"21433","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":608.61,"discounted_cash":304.31,"setting":"both","billing_class":"facility"}]},{"description":"ACTIVE WND CARE >20","code_information":[{"code":"21434","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":276.87,"discounted_cash":138.44,"setting":"both","billing_class":"facility"}]},{"description":"WND CARE NON-SELECT","code_information":[{"code":"21435","type":"CDM"},{"code":"361","type":"RC"},{"code":"97602","type":"CPT"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":284.87,"discounted_cash":142.44,"setting":"both","billing_class":"facility"}]},{"description":"APP MLTL CMP LWRLG B","code_information":[{"code":"21436","type":"CDM"},{"code":"361","type":"RC"},{"code":"29581","type":"CPT"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.71,"discounted_cash":315.36,"setting":"both","billing_class":"facility"}]},{"description":"APP MLTL CMP LWRLG R","code_information":[{"code":"21440","type":"CDM"},{"code":"361","type":"RC"},{"code":"29581","type":"CPT"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":315.28,"discounted_cash":157.64,"setting":"both","billing_class":"facility"}]},{"description":"APP MLTL CMP LWRLG L","code_information":[{"code":"21441","type":"CDM"},{"code":"361","type":"RC"},{"code":"29581","type":"CPT"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":315.28,"discounted_cash":157.64,"setting":"both","billing_class":"facility"}]},{"description":"APP SKN T/A/L >25SQ","code_information":[{"code":"21442","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2847.31,"discounted_cash":1423.65,"setting":"both","billing_class":"facility"}]},{"description":"APP SKN T/A/L ADD 25","code_information":[{"code":"21443","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.28,"discounted_cash":110.64,"setting":"both","billing_class":"facility"}]},{"description":"APP SKN T/A/L 100SQ","code_information":[{"code":"21444","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":4122.68,"discounted_cash":2061.34,"setting":"both","billing_class":"facility"}]},{"description":"APP SKN T/A/L ADD100","code_information":[{"code":"21445","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":632.02,"discounted_cash":316.01,"setting":"both","billing_class":"facility"}]},{"description":"APP SKN HD/HNDS 25SQ","code_information":[{"code":"21446","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2847.31,"discounted_cash":1423.65,"setting":"both","billing_class":"facility"}]},{"description":"APP SKN HD/HNDS ADD","code_information":[{"code":"21447","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.28,"discounted_cash":110.64,"setting":"both","billing_class":"facility"}]},{"description":"APP SKN HD/HNDS 100","code_information":[{"code":"21448","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":4069.49,"discounted_cash":2034.74,"setting":"both","billing_class":"facility"}]},{"description":"APP SKN HD/HNDS ADD","code_information":[{"code":"21449","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":530.76,"discounted_cash":265.38,"setting":"both","billing_class":"facility"}]},{"description":"LC SS T/A/L > 25SQ","code_information":[{"code":"21450","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1567.34,"discounted_cash":783.67,"setting":"both","billing_class":"facility"}]},{"description":"LC SS HEAD/HAND 25SQ","code_information":[{"code":"21454","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1567.34,"discounted_cash":783.67,"setting":"both","billing_class":"facility"}]},{"description":"LC SS HEAD/HNDS ADD","code_information":[{"code":"21455","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":600.35,"discounted_cash":300.18,"setting":"both","billing_class":"facility"}]},{"description":"LC SS F/H/N 100","code_information":[{"code":"21456","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2721.86,"discounted_cash":1360.93,"setting":"both","billing_class":"facility"}]},{"description":"EX BEN LES 0.6-1CM","code_information":[{"code":"21459","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1101.9,"discounted_cash":550.95,"setting":"both","billing_class":"facility"}]},{"description":"EX BEN LES 4.1CM/>","code_information":[{"code":"21460","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":3502.11,"discounted_cash":1751.06,"setting":"both","billing_class":"facility"}]},{"description":"EX BEN LES 1.1-2CM","code_information":[{"code":"21461","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1963.19,"discounted_cash":981.6,"setting":"both","billing_class":"facility"}]},{"description":"EX BEN LES 2.1-3CM","code_information":[{"code":"21462","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1963.19,"discounted_cash":981.6,"setting":"both","billing_class":"facility"}]},{"description":"EX BEN LES <0.5CM","code_information":[{"code":"21464","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1963.19,"discounted_cash":981.6,"setting":"both","billing_class":"facility"}]},{"description":"EX BEN LES .6-1CM","code_information":[{"code":"21465","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1963.19,"discounted_cash":981.6,"setting":"both","billing_class":"facility"}]},{"description":"EX BEN LES 2.1-3CM","code_information":[{"code":"21466","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1963.19,"discounted_cash":981.6,"setting":"both","billing_class":"facility"}]},{"description":"EX BEN LES 3.1-4CM","code_information":[{"code":"21467","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":3502.11,"discounted_cash":1751.06,"setting":"both","billing_class":"facility"}]},{"description":"EX BEN LES >4.1CM","code_information":[{"code":"21468","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":3502.11,"discounted_cash":1751.06,"setting":"both","billing_class":"facility"}]},{"description":"DEBRIDE NAILS 1-5","code_information":[{"code":"21469","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":192.07,"discounted_cash":96.03,"setting":"both","billing_class":"facility"}]},{"description":"DEBRIDE NAILS 6 PLUS","code_information":[{"code":"21470","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":192.07,"discounted_cash":96.03,"setting":"both","billing_class":"facility"}]},{"description":"PURAPLY PER SQ CM","code_information":[{"code":"21471","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4195","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":365.67,"discounted_cash":182.84,"setting":"both","billing_class":"facility"}]},{"description":"DRAINAGE FINGER SIMP","code_information":[{"code":"21472","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":670.32,"discounted_cash":335.16,"setting":"both","billing_class":"facility"}]},{"description":"TANGNTL BX SKIN SING","code_information":[{"code":"21473","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":598.79,"discounted_cash":299.39,"setting":"both","billing_class":"facility"}]},{"description":"PUNCH BX SKIN SINGLE","code_information":[{"code":"21474","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":598.79,"discounted_cash":299.39,"setting":"both","billing_class":"facility"}]},{"description":"PURAPLY AM PER SQ CT","code_information":[{"code":"21475","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4196","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":382.48,"discounted_cash":191.24,"setting":"both","billing_class":"facility"}]},{"description":"EX BEN LES <0.5CM","code_information":[{"code":"21479","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1101.9,"discounted_cash":550.95,"setting":"both","billing_class":"facility"}]},{"description":"EX BEN LES 3.1-4CM","code_information":[{"code":"21480","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1963.19,"discounted_cash":981.6,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX PRIME 1.5X2CM","code_information":[{"code":"21481","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1150.51,"discounted_cash":575.25,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX PRIME 2 X 3CM","code_information":[{"code":"21482","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1581.99,"discounted_cash":791.0,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX PRIME 3 X 4CM","code_information":[{"code":"21483","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1941.45,"discounted_cash":970.73,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX PRIME PL 16MM","code_information":[{"code":"21484","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1434.9,"discounted_cash":717.45,"setting":"both","billing_class":"facility"}]},{"description":"GRAFIX PRIME PL/SQCM","code_information":[{"code":"21485","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":429.22,"discounted_cash":214.61,"setting":"both","billing_class":"facility"}]},{"description":"OASIS TRILAYER SQ CM","code_information":[{"code":"21486","type":"CDM"},{"code":"636","type":"RC"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":51.35,"discounted_cash":25.68,"setting":"both","modifier_code":["Q4","32"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier Q4: Service for ordering/referring physician qualifies as a service exemption | Modifier 32: Mandated Services"}]},{"description":"DSG OASIS 3X7 21 SQ","code_information":[{"code":"21487","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.18,"discounted_cash":17.09,"setting":"both","billing_class":"facility"}]},{"description":"DSG OASIS 3.5X3 11SQ","code_information":[{"code":"21488","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.34,"discounted_cash":16.17,"setting":"both","billing_class":"facility"}]},{"description":"DSG OASIS 5X7 35 SQ","code_information":[{"code":"21489","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.21,"discounted_cash":17.61,"setting":"both","billing_class":"facility"}]},{"description":"OASIS BURN MTRX 1SQ","code_information":[{"code":"21490","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4103","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":45.72,"discounted_cash":22.86,"setting":"both","billing_class":"facility"}]},{"description":"AUTOLOGEL PRP ULCERS","code_information":[{"code":"21491","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0460","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2786.44,"discounted_cash":1393.22,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES <.5CM","code_information":[{"code":"21492","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2026.52,"discounted_cash":1013.26,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES 0.6-1CM","code_information":[{"code":"21493","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1519.9,"discounted_cash":759.95,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES 1.1-2CM","code_information":[{"code":"21494","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1519.9,"discounted_cash":759.95,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES 2.1-3CM","code_information":[{"code":"21495","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2026.52,"discounted_cash":1013.26,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES 3.1-4CM","code_information":[{"code":"21496","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2026.52,"discounted_cash":1013.26,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES >4CM","code_information":[{"code":"21497","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":3502.11,"discounted_cash":1751.06,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES <.5CM","code_information":[{"code":"21498","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2026.52,"discounted_cash":1013.26,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES 0.6-1CM","code_information":[{"code":"21499","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1519.9,"discounted_cash":759.95,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES 1.1-2CM","code_information":[{"code":"21500","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1126.14,"discounted_cash":563.07,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES 2.1-3CM","code_information":[{"code":"21501","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2026.52,"discounted_cash":1013.26,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES 3.1-4CM","code_information":[{"code":"21502","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2026.52,"discounted_cash":1013.26,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES >4CM","code_information":[{"code":"21503","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":3502.11,"discounted_cash":1751.06,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES <.5CM","code_information":[{"code":"21504","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2026.52,"discounted_cash":1013.26,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES 0.6-1CM","code_information":[{"code":"21505","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2026.52,"discounted_cash":1013.26,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES 1.1-2CM","code_information":[{"code":"21506","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2026.52,"discounted_cash":1013.26,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES 2.1-3CM","code_information":[{"code":"21507","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":2026.52,"discounted_cash":1013.26,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES 3.1-4CM","code_information":[{"code":"21508","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":3502.11,"discounted_cash":1751.06,"setting":"both","billing_class":"facility"}]},{"description":"EXC MAL LES >4CM","code_information":[{"code":"21509","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":3502.11,"discounted_cash":1751.06,"setting":"both","billing_class":"facility"}]},{"description":"REPAIR INT WND 2.5<","code_information":[{"code":"21510","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":569.94,"discounted_cash":284.97,"setting":"both","billing_class":"facility"}]},{"description":"CLOSURE PLIT WOUND","code_information":[{"code":"21511","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1700.37,"discounted_cash":850.18,"setting":"both","billing_class":"facility"}]},{"description":"WCC GLUCOSE BY DEV","code_information":[{"code":"21512","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"CPT"},{"code":"607","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.6,"discounted_cash":10.3,"setting":"both","billing_class":"facility"}]},{"description":"SUTURES G11","code_information":[{"code":"21520","type":"CDM"},{"code":"272","type":"RC"},{"code":"90471","type":"CPT"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":40.13,"setting":"both","billing_class":"facility"}]},{"description":"M/S 2 TELE PVT","code_information":[{"code":"22","type":"CDM"},{"code":"206","type":"RC"},{"code":"G0379","type":"HCPCS"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":2500.0,"discounted_cash":1250.0,"setting":"both","billing_class":"facility"}]},{"description":"TECVAYLI 0.5MG(30/3)","code_information":[{"code":"22099","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9380","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.82,"discounted_cash":32.41,"setting":"both","billing_class":"facility"}]},{"description":"SYS CORVOCET BIOPSY","code_information":[{"code":"22100","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":178.5,"discounted_cash":89.25,"setting":"both","billing_class":"facility"}]},{"description":"TECVA 0.5MG(153/1.7)","code_information":[{"code":"22101","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9380","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.82,"discounted_cash":32.41,"setting":"both","billing_class":"facility"}]},{"description":"INJ TENDON SHTH/LIGA","code_information":[{"code":"22102","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1034.29,"discounted_cash":517.14,"setting":"both","billing_class":"facility"}]},{"description":"PIFLU F-18, DIA 1 MI","code_information":[{"code":"22103","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9595","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2045.07,"discounted_cash":1022.53,"setting":"both","billing_class":"facility"}]},{"description":"BEVAC-MALY(ALY)10MG","code_information":[{"code":"22104","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5126","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":195.26,"discounted_cash":97.63,"setting":"both","billing_class":"facility"}]},{"description":"BEVAC-MALY(ALY)10MG","code_information":[{"code":"22105","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5126","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":195.26,"discounted_cash":97.63,"setting":"both","billing_class":"facility"}]},{"description":"LUSPATER-AAMT 25/.25","code_information":[{"code":"22106","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0896","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.72,"discounted_cash":40.36,"setting":"both","billing_class":"facility"}]},{"description":"RETRACTOR ALEXIS LAP","code_information":[{"code":"22107","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.25,"discounted_cash":337.63,"setting":"both","billing_class":"facility"}]},{"description":"MYD88 GENE P.LEU265P","code_information":[{"code":"22108","type":"CDM"},{"code":"310","type":"RC"},{"code":"81305","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":670.5,"discounted_cash":335.25,"setting":"both","billing_class":"facility"}]},{"description":"DILATOR VASCULAR","code_information":[{"code":"22109","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"853","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO IVP SINGL DRUG","code_information":[{"code":"22110","type":"CDM"},{"code":"331","type":"RC"},{"code":"96409","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":1073.22,"discounted_cash":536.61,"setting":"both","billing_class":"facility"}]},{"description":"ABL1 GENE  ZB3RV","code_information":[{"code":"22111","type":"CDM"},{"code":"310","type":"RC"},{"code":"81170","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":1052.0,"discounted_cash":526.0,"setting":"both","billing_class":"facility"}]},{"description":"CATH BALN EZDILATE","code_information":[{"code":"22112","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1750","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility"}]},{"description":"TUBE/TUBING G26","code_information":[{"code":"22113","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":279.5,"discounted_cash":139.75,"setting":"both","billing_class":"facility"}]},{"description":"UNL PX LUNGS PLEURA","code_information":[{"code":"22114","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"685","type":"LOCAL"}],"standard_charges":[{"gross_charge":1728.25,"discounted_cash":864.13,"setting":"both","billing_class":"facility"}]},{"description":"RETRACTOR G29","code_information":[{"code":"22116","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4133","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":269.45,"discounted_cash":134.72,"setting":"both","billing_class":"facility"}]},{"description":"ROMIPLOSTIM 125MCG V","code_information":[{"code":"22117","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2802","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":13.9,"setting":"both","billing_class":"facility"}]},{"description":"BENZ BENZYLPCN 4ML","code_information":[{"code":"22118","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0883","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.63,"discounted_cash":25.32,"setting":"both","billing_class":"facility"}]},{"description":"CEFAZOLIN 2GM (500J)","code_information":[{"code":"22119","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.31,"discounted_cash":2.65,"setting":"both","billing_class":"facility"}]},{"description":"CEFAZOLIN 3GM (500J)","code_information":[{"code":"22120","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0688","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.09,"discounted_cash":2.54,"setting":"both","billing_class":"facility"}]},{"description":"CABOT/RILP 2MG/3MG J","code_information":[{"code":"22121","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0741","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.1,"discounted_cash":23.05,"setting":"both","billing_class":"facility"}]},{"description":"MR SFTY IMPLT/FB 1ST","code_information":[{"code":"22123","type":"CDM"},{"code":"610","type":"RC"},{"code":"76014","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":114.75,"discounted_cash":57.38,"setting":"both","billing_class":"facility"}]},{"description":"MR SFTY IMPLT&/FB 15","code_information":[{"code":"22124","type":"CDM"},{"code":"610","type":"RC"},{"code":"76014","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":114.75,"discounted_cash":57.38,"setting":"both","billing_class":"facility"}]},{"description":"MR SFTY MPLT&/FB ADD","code_information":[{"code":"22125","type":"CDM"},{"code":"610","type":"RC"},{"code":"76015","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":114.75,"discounted_cash":57.38,"setting":"both","billing_class":"facility"}]},{"description":"MR SFTY DETER PHYS","code_information":[{"code":"22126","type":"CDM"},{"code":"610","type":"RC"},{"code":"76016","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":383.5,"discounted_cash":191.75,"setting":"both","billing_class":"facility"}]},{"description":"MR SFTY MED PHYSICS","code_information":[{"code":"22127","type":"CDM"},{"code":"610","type":"RC"},{"code":"76017","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":970.0,"discounted_cash":485.0,"setting":"both","billing_class":"facility"}]},{"description":"MR SFTY IMPLT ELECTR","code_information":[{"code":"22128","type":"CDM"},{"code":"610","type":"RC"},{"code":"76018","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":399.75,"discounted_cash":199.88,"setting":"both","billing_class":"facility"}]},{"description":"MR SFTY IMPLT POS","code_information":[{"code":"22129","type":"CDM"},{"code":"610","type":"RC"},{"code":"76019","type":"CPT"},{"code":"742","type":"LOCAL"}],"standard_charges":[{"gross_charge":258.75,"discounted_cash":129.38,"setting":"both","billing_class":"facility"}]},{"description":"MICAFUNGIN INJ 1 MG","code_information":[{"code":"22130","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2247","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":2.08,"setting":"both","billing_class":"facility"}]},{"description":"AGP ANTI GLADIN IGA","code_information":[{"code":"237","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.2,"discounted_cash":52.1,"setting":"both","billing_class":"facility"}]},{"description":"AGP ANTI GLADIN IGG","code_information":[{"code":"238","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.2,"discounted_cash":52.1,"setting":"both","billing_class":"facility"}]},{"description":"IGGSP IGG TOTAL","code_information":[{"code":"239","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.35,"discounted_cash":18.18,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD ADMINISTRATION","code_information":[{"code":"24","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":935.38,"discounted_cash":467.69,"setting":"both","billing_class":"facility"}]},{"description":"IGGSP IGG SUBCLASSES","code_information":[{"code":"240","type":"CDM"},{"code":"300","type":"RC"},{"code":"82787","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":15.15,"setting":"both","billing_class":"facility"}]},{"description":"IGGSP IGG SUBCLASS 2","code_information":[{"code":"241","type":"CDM"},{"code":"300","type":"RC"},{"code":"82787","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":15.15,"setting":"both","billing_class":"facility"}]},{"description":"SEAL ENDO DAVINCI","code_information":[{"code":"2416","type":"CDM"},{"code":"272","type":"RC"},{"code":"11402","type":"CPT"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":12.38,"setting":"both","billing_class":"facility"}]},{"description":"EMERGENCY INTUBATION","code_information":[{"code":"2417","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":396.42,"discounted_cash":198.21,"setting":"both","billing_class":"facility"}]},{"description":"OR LVL I 1ST 30 MIN","code_information":[{"code":"2418","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":7484.77,"discounted_cash":3742.39,"setting":"both","billing_class":"facility"}]},{"description":"OR LVL I EA ADD 15MN","code_information":[{"code":"2419","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1277.09,"discounted_cash":638.54,"setting":"both","billing_class":"facility"}]},{"description":"IGGSP IGG SUBCLASS 3","code_information":[{"code":"242","type":"CDM"},{"code":"300","type":"RC"},{"code":"82787","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":15.15,"setting":"both","billing_class":"facility"}]},{"description":"OR LVL II 1ST 30 MIN","code_information":[{"code":"2420","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":8145.15,"discounted_cash":4072.57,"setting":"both","billing_class":"facility"}]},{"description":"OR LVL II EA AD 15M","code_information":[{"code":"2421","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1459.09,"discounted_cash":729.54,"setting":"both","billing_class":"facility"}]},{"description":"OR LVL III 1ST 30 M","code_information":[{"code":"2422","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":8551.55,"discounted_cash":4275.77,"setting":"both","billing_class":"facility"}]},{"description":"OR LVL III EA AD 15M","code_information":[{"code":"2423","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1605.9,"discounted_cash":802.95,"setting":"both","billing_class":"facility"}]},{"description":"OR LVL IV 1ST 30 MIN","code_information":[{"code":"2424","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":8839.5,"discounted_cash":4419.75,"setting":"both","billing_class":"facility"}]},{"description":"OR LVL IV EA AD 15M","code_information":[{"code":"2425","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1749.8,"discounted_cash":874.9,"setting":"both","billing_class":"facility"}]},{"description":"INTRAOPERATIVE US","code_information":[{"code":"2426","type":"CDM"},{"code":"402","type":"RC"},{"code":"76998","type":"CPT"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":540.84,"discounted_cash":270.42,"setting":"both","billing_class":"facility"}]},{"description":"IONM OR CONT 15 MIN","code_information":[{"code":"2428","type":"CDM"},{"code":"920","type":"RC"},{"code":"95940","type":"CPT"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1477.26,"discounted_cash":738.63,"setting":"both","billing_class":"facility"}]},{"description":"NEURO UP EXT EVOKES","code_information":[{"code":"2429","type":"CDM"},{"code":"920","type":"RC"},{"code":"95925","type":"CPT"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.51,"discounted_cash":440.75,"setting":"both","billing_class":"facility"}]},{"description":"IGGSP IGG SUBCLASS 4","code_information":[{"code":"243","type":"CDM"},{"code":"300","type":"RC"},{"code":"82787","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":15.15,"setting":"both","billing_class":"facility"}]},{"description":"NEURO LWR EXT EVOKES","code_information":[{"code":"2430","type":"CDM"},{"code":"920","type":"RC"},{"code":"95926","type":"CPT"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.08,"discounted_cash":423.04,"setting":"both","billing_class":"facility"}]},{"description":"NEURO EMG EVOKES","code_information":[{"code":"2432","type":"CDM"},{"code":"920","type":"RC"},{"code":"95864","type":"CPT"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":386.91,"discounted_cash":193.46,"setting":"both","billing_class":"facility"}]},{"description":"EP STDY UP/LW LIMB","code_information":[{"code":"2433","type":"CDM"},{"code":"920","type":"RC"},{"code":"95938","type":"CPT"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1192.45,"discounted_cash":596.23,"setting":"both","billing_class":"facility"}]},{"description":"NEURO TST LWR LIMB","code_information":[{"code":"2434","type":"CDM"},{"code":"920","type":"RC"},{"code":"95928","type":"CPT"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1963.19,"discounted_cash":981.6,"setting":"both","billing_class":"facility"}]},{"description":"CM EP STDY U/L LIMBS","code_information":[{"code":"2435","type":"CDM"},{"code":"920","type":"RC"},{"code":"95939","type":"CPT"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1906.6,"discounted_cash":953.3,"setting":"both","billing_class":"facility"}]},{"description":"NEURO TST UP LIMB","code_information":[{"code":"2436","type":"CDM"},{"code":"920","type":"RC"},{"code":"95929","type":"CPT"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1963.19,"discounted_cash":981.6,"setting":"both","billing_class":"facility"}]},{"description":"ANALYZE NEUROSTM CMP","code_information":[{"code":"2437","type":"CDM"},{"code":"920","type":"RC"},{"code":"95972","type":"CPT"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":568.69,"discounted_cash":284.35,"setting":"both","billing_class":"facility"}]},{"description":"MINOR PROCEDURE 1","code_information":[{"code":"2438","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1135.58,"discounted_cash":567.79,"setting":"both","billing_class":"facility"}]},{"description":"MINOR PROCEDURE 2","code_information":[{"code":"2439","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":3926.51,"discounted_cash":1963.26,"setting":"both","billing_class":"facility"}]},{"description":"MINOR PROCEDURE 3","code_information":[{"code":"2440","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":4964.09,"discounted_cash":2482.05,"setting":"both","billing_class":"facility"}]},{"description":"CARDIOVERSION EXTERN","code_information":[{"code":"2441","type":"CDM"},{"code":"480","type":"RC"},{"code":"92960","type":"CPT"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1679.32,"discounted_cash":839.66,"setting":"both","billing_class":"facility"}]},{"description":"LC SS APPLICATION","code_information":[{"code":"2442","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":600.35,"discounted_cash":300.18,"setting":"both","billing_class":"facility"}]},{"description":"LC SS HEAD/HAND","code_information":[{"code":"2443","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1817.83,"discounted_cash":908.91,"setting":"both","billing_class":"facility"}]},{"description":"INJ AA/STRD BRACH PL","code_information":[{"code":"2444","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":2421.0,"discounted_cash":1210.5,"setting":"both","billing_class":"facility"}]},{"description":"RELOAD DAVINCI VARIO","code_information":[{"code":"2445","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.3,"discounted_cash":399.65,"setting":"both","billing_class":"facility"}]},{"description":"ACCESORY TIP COVER","code_information":[{"code":"2446","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.1,"discounted_cash":43.55,"setting":"both","billing_class":"facility"}]},{"description":"SEAL CANNULA 5-8","code_information":[{"code":"2447","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.25,"discounted_cash":39.13,"setting":"both","billing_class":"facility"}]},{"description":"OBTURATOR 8MM BLADEL","code_information":[{"code":"2448","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":122.35,"discounted_cash":61.17,"setting":"both","billing_class":"facility"}]},{"description":"REDUCER 12-8","code_information":[{"code":"2449","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":101.45,"discounted_cash":50.73,"setting":"both","billing_class":"facility"}]},{"description":"VESSEL SEALER EXT DA","code_information":[{"code":"2450","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1809.2,"discounted_cash":904.6,"setting":"both","billing_class":"facility"}]},{"description":"STAPLER SUREFORM 60","code_information":[{"code":"2451","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1487.25,"discounted_cash":743.63,"setting":"both","billing_class":"facility"}]},{"description":"SEAL 12MM STAPLER CA","code_information":[{"code":"2452","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.1,"discounted_cash":43.55,"setting":"both","billing_class":"facility"}]},{"description":"SET INSUFL TBG .027","code_information":[{"code":"2453","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.95,"discounted_cash":31.98,"setting":"both","billing_class":"facility"}]},{"description":"AIRSEALS DAVINCI VAR","code_information":[{"code":"2454","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":299.9,"discounted_cash":149.95,"setting":"both","billing_class":"facility"}]},{"description":"CLIP MEDIUM DAVINCI","code_information":[{"code":"2455","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.15,"discounted_cash":60.08,"setting":"both","billing_class":"facility"}]},{"description":"IRRIGATOR SUCTION EN","code_information":[{"code":"2456","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":843.4,"discounted_cash":421.7,"setting":"both","billing_class":"facility"}]},{"description":"OCCLUDER COLPO PNEUM","code_information":[{"code":"2457","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.85,"discounted_cash":101.42,"setting":"both","billing_class":"facility"}]},{"description":"TIP RUMI","code_information":[{"code":"2458","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":168.7,"discounted_cash":84.35,"setting":"both","billing_class":"facility"}]},{"description":"SEAL ENDO","code_information":[{"code":"2459","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.25,"discounted_cash":39.13,"setting":"both","billing_class":"facility"}]},{"description":"SET INSUFL TBG .027","code_information":[{"code":"2460","type":"CDM"},{"code":"272","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.95,"discounted_cash":31.98,"setting":"both","billing_class":"facility"}]},{"description":"IMP RUMI KC-RUMI-35","code_information":[{"code":"2461","type":"CDM"},{"code":"278","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":337.59,"discounted_cash":168.79,"setting":"both","billing_class":"facility"}]},{"description":"ADDUCTOR CANAL BLOCK","code_information":[{"code":"2462","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"416","type":"LOCAL"}],"standard_charges":[{"gross_charge":2510.19,"discounted_cash":1255.1,"setting":"both","billing_class":"facility"}]},{"description":"PH I REC RM 1ST 30MN","code_information":[{"code":"2463","type":"CDM"},{"code":"710","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"414","type":"LOCAL"}],"standard_charges":[{"gross_charge":1268.73,"discounted_cash":634.37,"setting":"both","billing_class":"facility"}]},{"description":"PH I REC RM ADD 15","code_information":[{"code":"2464","type":"CDM"},{"code":"710","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"414","type":"LOCAL"}],"standard_charges":[{"gross_charge":91.75,"discounted_cash":45.88,"setting":"both","billing_class":"facility"}]},{"description":"PH II REC RM 1ST 30","code_information":[{"code":"2465","type":"CDM"},{"code":"710","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"414","type":"LOCAL"}],"standard_charges":[{"gross_charge":1159.95,"discounted_cash":579.98,"setting":"both","billing_class":"facility"}]},{"description":"PH II REC RM ADDL 15","code_information":[{"code":"2466","type":"CDM"},{"code":"710","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"414","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.24,"discounted_cash":37.62,"setting":"both","billing_class":"facility"}]},{"description":"POSTPART HEM W INSTR","code_information":[{"code":"2467","type":"CDM"},{"code":"361","type":"RC"},{"code":"MANUL","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":637.5,"discounted_cash":318.75,"setting":"both","billing_class":"facility"}]},{"description":"TRANSABD AMNIOINF US","code_information":[{"code":"2468","type":"CDM"},{"code":"361","type":"RC"},{"code":"MANUL","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":957.64,"discounted_cash":478.82,"setting":"both","billing_class":"facility"}]},{"description":"VAG AMNIOINF W US","code_information":[{"code":"2469","type":"CDM"},{"code":"361","type":"RC"},{"code":"MANUL","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":637.5,"discounted_cash":318.75,"setting":"both","billing_class":"facility"}]},{"description":"REC RM EA 15 MIN","code_information":[{"code":"2470","type":"CDM"},{"code":"710","type":"RC"},{"code":"MANUL","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":91.75,"discounted_cash":45.88,"setting":"both","billing_class":"facility"}]},{"description":"DELIVERY VAG LVL I","code_information":[{"code":"2471","type":"CDM"},{"code":"721","type":"RC"},{"code":"MANUL","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":3003.59,"discounted_cash":1501.8,"setting":"both","billing_class":"facility"}]},{"description":"DELIVERY VAG LVL II","code_information":[{"code":"2472","type":"CDM"},{"code":"721","type":"RC"},{"code":"MANUL","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":3378.49,"discounted_cash":1689.24,"setting":"both","billing_class":"facility"}]},{"description":"DELIVERY VAG LVL III","code_information":[{"code":"2473","type":"CDM"},{"code":"721","type":"RC"},{"code":"MANUL","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":3584.92,"discounted_cash":1792.46,"setting":"both","billing_class":"facility"}]},{"description":"IP LABOR LEVEL 1 1ST","code_information":[{"code":"2474","type":"CDM"},{"code":"721","type":"RC"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":423.75,"discounted_cash":211.88,"setting":"both","billing_class":"facility"}]},{"description":"IP LABOR LEVEL 1 EA","code_information":[{"code":"2475","type":"CDM"},{"code":"721","type":"RC"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.98,"discounted_cash":26.49,"setting":"both","billing_class":"facility"}]},{"description":"IP LABOR LEV2 1ST HR","code_information":[{"code":"2476","type":"CDM"},{"code":"721","type":"RC"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":533.47,"discounted_cash":266.74,"setting":"both","billing_class":"facility"}]},{"description":"IP LAB LEV2 EA AD HR","code_information":[{"code":"2477","type":"CDM"},{"code":"721","type":"RC"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.76,"discounted_cash":30.88,"setting":"both","billing_class":"facility"}]},{"description":"IP LAB LEV 3 1ST HR","code_information":[{"code":"2478","type":"CDM"},{"code":"721","type":"RC"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":643.2,"discounted_cash":321.6,"setting":"both","billing_class":"facility"}]},{"description":"IP LAB LEV 3EA AD HR","code_information":[{"code":"2479","type":"CDM"},{"code":"721","type":"RC"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.54,"discounted_cash":35.27,"setting":"both","billing_class":"facility"}]},{"description":"OP EST PT LEVEL 1","code_information":[{"code":"2481","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":60.6,"setting":"both","billing_class":"facility"}]},{"description":"OP EST PT LEVEL 2","code_information":[{"code":"2482","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":212.1,"discounted_cash":106.05,"setting":"both","billing_class":"facility"}]},{"description":"OP EST PT LEVEL 3","code_information":[{"code":"2483","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.05,"discounted_cash":151.53,"setting":"both","billing_class":"facility"}]},{"description":"OP EST PT LEVEL 4","code_information":[{"code":"2484","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.9,"discounted_cash":196.95,"setting":"both","billing_class":"facility"}]},{"description":"OP EST PT LEVEL 5","code_information":[{"code":"2485","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":484.8,"discounted_cash":242.4,"setting":"both","billing_class":"facility"}]},{"description":"OXYGEN PER DAY","code_information":[{"code":"2486","type":"CDM"},{"code":"270","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":808.8,"discounted_cash":404.4,"setting":"both","billing_class":"facility"}]},{"description":"OP NEW PT LEVEL 1","code_information":[{"code":"2487","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":60.6,"setting":"both","billing_class":"facility"}]},{"description":"OP NEW PT LEVEL 2","code_information":[{"code":"2488","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":212.1,"discounted_cash":106.05,"setting":"both","billing_class":"facility"}]},{"description":"OP NEW PT LEVEL 3","code_information":[{"code":"2489","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.05,"discounted_cash":151.53,"setting":"both","billing_class":"facility"}]},{"description":"OP NEW PT LEVEL 4","code_information":[{"code":"2491","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.9,"discounted_cash":196.95,"setting":"both","billing_class":"facility"}]},{"description":"OP NEW PT LEVEL 5","code_information":[{"code":"2492","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":484.8,"discounted_cash":242.4,"setting":"both","billing_class":"facility"}]},{"description":"OB US LTD FETUS(S)","code_information":[{"code":"2494","type":"CDM"},{"code":"402","type":"RC"},{"code":"76815","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":284.87,"discounted_cash":142.44,"setting":"both","billing_class":"facility"}]},{"description":"EXTERNAL VERSION","code_information":[{"code":"2498","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":3593.15,"discounted_cash":1796.58,"setting":"both","billing_class":"facility"}]},{"description":"IMMUN ADMIN 1ST VACC","code_information":[{"code":"25","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.94,"discounted_cash":47.47,"setting":"both","billing_class":"facility"}]},{"description":"FETAL NON STRSS TEST","code_information":[{"code":"2501","type":"CDM"},{"code":"761","type":"RC"},{"code":"59025","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":505.89,"discounted_cash":252.94,"setting":"both","billing_class":"facility"}]},{"description":"L&D OBS 1ST HOUR","code_information":[{"code":"2502","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":651.51,"discounted_cash":325.75,"setting":"both","billing_class":"facility"}]},{"description":"L&D OBS EA ADDL HOUR","code_information":[{"code":"2503","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":109.1,"discounted_cash":54.55,"setting":"both","billing_class":"facility"}]},{"description":"L&D OBS DIRECT ADMIT","code_information":[{"code":"2504","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0379","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":1797.56,"discounted_cash":898.78,"setting":"both","billing_class":"facility"}]},{"description":"FETAL CONTRACTION ST","code_information":[{"code":"2505","type":"CDM"},{"code":"361","type":"RC"},{"code":"59020","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.4,"discounted_cash":315.2,"setting":"both","billing_class":"facility"}]},{"description":"VENIPUNCTURE","code_information":[{"code":"2507","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.65,"discounted_cash":15.32,"setting":"both","billing_class":"facility"}]},{"description":"TRANSFUSION ADMIN","code_information":[{"code":"2509","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":935.38,"discounted_cash":467.69,"setting":"both","billing_class":"facility"}]},{"description":"IMMUN ADMIN 1ST VACC","code_information":[{"code":"2510","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":99.43,"discounted_cash":49.72,"setting":"both","billing_class":"facility"}]},{"description":"IMMUN ADMIN ADDL VAC","code_information":[{"code":"2511","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.35,"discounted_cash":23.18,"setting":"both","billing_class":"facility"}]},{"description":"ADMIN INFLUENZA VACC","code_information":[{"code":"2512","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.65,"discounted_cash":34.83,"setting":"both","billing_class":"facility"}]},{"description":"ADMIN PNEUMO VACCINE","code_information":[{"code":"2513","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.46,"discounted_cash":36.73,"setting":"both","billing_class":"facility"}]},{"description":"ADMIN HEB B VACCINE","code_information":[{"code":"2514","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0010","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.92,"discounted_cash":88.46,"setting":"both","billing_class":"facility"}]},{"description":"IV INF HYDR INTL HR","code_information":[{"code":"2515","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":294.1,"discounted_cash":147.05,"setting":"both","billing_class":"facility"}]},{"description":"IV INF HYDR ADDL HR","code_information":[{"code":"2516","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.3,"discounted_cash":26.65,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX1HR","code_information":[{"code":"2517","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":294.1,"discounted_cash":147.05,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX ADDL HR","code_information":[{"code":"2518","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX SEQ 1HR","code_information":[{"code":"2519","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":166.1,"discounted_cash":83.05,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX CONCRNT","code_information":[{"code":"2520","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.15,"discounted_cash":47.58,"setting":"both","billing_class":"facility"}]},{"description":"INJ IM/SQ","code_information":[{"code":"2522","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":53.88,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP SGL/INT SUB","code_information":[{"code":"2523","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":125.5,"discounted_cash":62.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP ADD/SEQ SUBS","code_information":[{"code":"2524","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":66.15,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP SAME SUBS","code_information":[{"code":"2525","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"CPT"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":196.5,"discounted_cash":98.25,"setting":"both","billing_class":"facility"}]},{"description":"OP BLADDER CATH","code_information":[{"code":"2526","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":287.95,"discounted_cash":143.97,"setting":"both","billing_class":"facility"}]},{"description":"LACT CONSULT PER DAY","code_information":[{"code":"2527","type":"CDM"},{"code":"720","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":411.99,"discounted_cash":206.0,"setting":"both","billing_class":"facility"}]},{"description":"VAGNAL DVRY PLACENT","code_information":[{"code":"2528","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":3725.74,"discounted_cash":1862.87,"setting":"both","billing_class":"facility"}]},{"description":"CERVICAL DILATOR IN","code_information":[{"code":"2529","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"415","type":"LOCAL"}],"standard_charges":[{"gross_charge":990.14,"discounted_cash":495.07,"setting":"both","billing_class":"facility"}]},{"description":"ACETAM 325MG T","code_information":[{"code":"2530","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.38,"setting":"both","billing_class":"facility"}]},{"description":"ACETAM LIQ 160MG/5ML","code_information":[{"code":"2533","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"ACETAM 500MG T","code_information":[{"code":"2536","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"ACETAM RS 120MG","code_information":[{"code":"2538","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":3.15,"setting":"both","billing_class":"facility"}]},{"description":"ACETAM RS 325MG","code_information":[{"code":"2539","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":3.15,"setting":"both","billing_class":"facility"}]},{"description":"ACETAM RS 650 MG","code_information":[{"code":"2540","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"ACET COD #3 T","code_information":[{"code":"2542","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.63,"setting":"both","billing_class":"facility"}]},{"description":"ACET,COD #4 T","code_information":[{"code":"2543","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"ACET,COD 12MG/5ML","code_information":[{"code":"2544","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"ALLOPUR 100 MG T","code_information":[{"code":"2545","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.65,"setting":"both","billing_class":"facility"}]},{"description":"ALLOPUR 300 MG T","code_information":[{"code":"2546","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"ASA 325MG T","code_information":[{"code":"2550","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"ASA BABY 81MG T","code_information":[{"code":"2551","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.48,"setting":"both","billing_class":"facility"}]},{"description":"ASA  325MG ECT","code_information":[{"code":"2552","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"ASA SUPP 600MG","code_information":[{"code":"2555","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"ASA BUFF 325MG T","code_information":[{"code":"2556","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.43,"setting":"both","billing_class":"facility"}]},{"description":"BUT,ASA,CAFF T","code_information":[{"code":"2564","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":2.85,"setting":"both","billing_class":"facility"}]},{"description":"CARISOP 350MG T","code_information":[{"code":"2566","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":1.1,"setting":"both","billing_class":"facility"}]},{"description":"COCAINE TS 4% APP","code_information":[{"code":"2568","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.75,"discounted_cash":36.38,"setting":"both","billing_class":"facility"}]},{"description":"CODEINE 30MG T","code_information":[{"code":"2569","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"COLCHICINE 0.6MG T","code_information":[{"code":"2570","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.55,"discounted_cash":6.28,"setting":"both","billing_class":"facility"}]},{"description":"CYCLOBENZ 10MG T","code_information":[{"code":"2571","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"DANTROLENE 25MG C","code_information":[{"code":"2572","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.18,"setting":"both","billing_class":"facility"}]},{"description":"HYDROMOR 2MG T","code_information":[{"code":"2579","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":1.1,"setting":"both","billing_class":"facility"}]},{"description":"PRAMOX HC TS 10G","code_information":[{"code":"2582","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":242.9,"discounted_cash":121.45,"setting":"both","billing_class":"facility"}]},{"description":"LIDO OINT 5% 35 G","code_information":[{"code":"2584","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":563.3,"discounted_cash":281.65,"setting":"both","billing_class":"facility"}]},{"description":"LIDO TS 4% 50ML","code_information":[{"code":"2585","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":60.1,"setting":"both","billing_class":"facility"}]},{"description":"LIDO 2% VISC 20ML","code_information":[{"code":"2586","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility"}]},{"description":"MEPERIDINE 50MG T","code_information":[{"code":"2587","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"METHOCAR 500MG T","code_information":[{"code":"2592","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.65,"setting":"both","billing_class":"facility"}]},{"description":"OXYCO,APAP 5/325 T","code_information":[{"code":"2598","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"IMMUN ADMIN ADD VACC","code_information":[{"code":"26","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":44.31,"discounted_cash":22.16,"setting":"both","billing_class":"facility"}]},{"description":"PENTAZ,NAL 50/0.5 T","code_information":[{"code":"2602","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":2.85,"setting":"both","billing_class":"facility"}]},{"description":"PHENAZOP 100MG T","code_information":[{"code":"2603","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":2.25,"setting":"both","billing_class":"facility"}]},{"description":"PROBENECID 500MG T","code_information":[{"code":"2606","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":1.07,"setting":"both","billing_class":"facility"}]},{"description":"PROPAR0.5% OS 15ML","code_information":[{"code":"2610","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":105.15,"discounted_cash":52.58,"setting":"both","billing_class":"facility"}]},{"description":"TETRAC OS 0.5% 2ML","code_information":[{"code":"2612","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":19.25,"setting":"both","billing_class":"facility"}]},{"description":"LIDOC URO 2% 10ML","code_information":[{"code":"2617","type":"CDM"},{"code":"250","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":11.63,"setting":"both","billing_class":"facility"}]},{"description":"HYDROM 0.5 MG SYRG J","code_information":[{"code":"2621","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":1.13,"setting":"both","billing_class":"facility"}]},{"description":"EPO ALFAEPBX PER1000","code_information":[{"code":"2622","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.78,"discounted_cash":12.89,"setting":"both","billing_class":"facility"}]},{"description":"TETRAC TS 2% APP","code_information":[{"code":"2627","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE 30MG SRT","code_information":[{"code":"2628","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":3.05,"setting":"both","billing_class":"facility"}]},{"description":"CHLORZOX 500MG T","code_information":[{"code":"2629","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE  60MG SRT","code_information":[{"code":"2630","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":5.83,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE 15MG SRT","code_information":[{"code":"2633","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility"}]},{"description":"KETOC SH 2% 120ML","code_information":[{"code":"2634","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":201.55,"discounted_cash":100.78,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL TD 25MCG/HR","code_information":[{"code":"2635","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.6,"discounted_cash":26.8,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL TD 50MCG/HR","code_information":[{"code":"2636","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":97.65,"discounted_cash":48.83,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL TD 75MCG/HR","code_information":[{"code":"2637","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":101.2,"discounted_cash":50.6,"setting":"both","billing_class":"facility"}]},{"description":"KETOROL TR 10MGT","code_information":[{"code":"2638","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":1.95,"setting":"both","billing_class":"facility"}]},{"description":"BROM/PSE/DM 5ML SYRP","code_information":[{"code":"2640","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility"}]},{"description":"LIDO,PRIL 2.5% 5G KI","code_information":[{"code":"2641","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.3,"discounted_cash":15.65,"setting":"both","billing_class":"facility"}]},{"description":"ALPRAZOL 0.25MG T","code_information":[{"code":"2644","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.48,"setting":"both","billing_class":"facility"}]},{"description":"ALPRAZOL 0.5MG T","code_information":[{"code":"2645","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.18,"setting":"both","billing_class":"facility"}]},{"description":"AMITRIPT 10MG T","code_information":[{"code":"2646","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"AMITRIPT 25MG T","code_information":[{"code":"2647","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"CARB,LEVO 25/100 T","code_information":[{"code":"2657","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"CARB,LEVO 25/250 T","code_information":[{"code":"2658","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility"}]},{"description":"CHLOR HYD 500/5ML","code_information":[{"code":"2660","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility"}]},{"description":"CLORAZEP 7.5MG T","code_information":[{"code":"2662","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":2.5,"setting":"both","billing_class":"facility"}]},{"description":"CHLORDIAZ 25MG C","code_information":[{"code":"2664","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"CHLORDIAZ 5MG C","code_information":[{"code":"2665","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.65,"setting":"both","billing_class":"facility"}]},{"description":"BACLOFEN 10MG T","code_information":[{"code":"2668","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":2.33,"setting":"both","billing_class":"facility"}]},{"description":"CHLORPROMAZIN 25MG T","code_information":[{"code":"2671","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.64,"discounted_cash":1.82,"setting":"both","billing_class":"facility"}]},{"description":"CLONAZEPAM 0.5MG T","code_information":[{"code":"2676","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"DESIPRAMINE 25MG T","code_information":[{"code":"2679","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.7,"discounted_cash":1.85,"setting":"both","billing_class":"facility"}]},{"description":"DIAZEPAM 2MG T","code_information":[{"code":"2681","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.57,"setting":"both","billing_class":"facility"}]},{"description":"DIAZEPAM 5MG T","code_information":[{"code":"2682","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.6,"setting":"both","billing_class":"facility"}]},{"description":"DOXEPIN 10MG C","code_information":[{"code":"2683","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"DOXEPIN 25MG C","code_information":[{"code":"2684","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"FLUPHENAZINE 1MG T","code_information":[{"code":"2687","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":4.13,"setting":"both","billing_class":"facility"}]},{"description":"FLUPHENAZINE 5MG T","code_information":[{"code":"2688","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":8.63,"setting":"both","billing_class":"facility"}]},{"description":"HALOPERIDOL 0.5MG T","code_information":[{"code":"2689","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.57,"setting":"both","billing_class":"facility"}]},{"description":"HALOPERIDOL 2MG T","code_information":[{"code":"2691","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.13,"setting":"both","billing_class":"facility"}]},{"description":"HALOPERIDOL 5MG","code_information":[{"code":"2692","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":1.07,"setting":"both","billing_class":"facility"}]},{"description":"HYDROXYZ 25MG C","code_information":[{"code":"2695","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.05,"setting":"both","billing_class":"facility"}]},{"description":"IV INF HYDR INTL HR","code_information":[{"code":"27","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":294.1,"discounted_cash":147.05,"setting":"both","billing_class":"facility"}]},{"description":"IMIPRAMINE 10MG T","code_information":[{"code":"2701","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.75,"setting":"both","billing_class":"facility"}]},{"description":"IMIPRAMINE 25MG T","code_information":[{"code":"2703","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.32,"setting":"both","billing_class":"facility"}]},{"description":"LITH CARB 300MG SRT","code_information":[{"code":"2707","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.88,"setting":"both","billing_class":"facility"}]},{"description":"LITHIUM CIT 300/ 5ML","code_information":[{"code":"2708","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"LORAZEPAM 1MG T","code_information":[{"code":"2710","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"LOXAP SUC 5MG C","code_information":[{"code":"2713","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"NORTRIPT 10MG C","code_information":[{"code":"2720","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"NORTRIP 25MG C","code_information":[{"code":"2721","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"OXAZEPAM 15MG C","code_information":[{"code":"2723","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"CARBAMAZ  200MG T","code_information":[{"code":"2727","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":2.7,"setting":"both","billing_class":"facility"}]},{"description":"PHENOB 20/5 5ML","code_information":[{"code":"2734","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"PHENOB 30MG T","code_information":[{"code":"2735","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"PHENYTOIN 100MG C DI","code_information":[{"code":"2736","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"PHENYTOIN 125/5 5ML","code_information":[{"code":"2737","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.43,"setting":"both","billing_class":"facility"}]},{"description":"PHENYTOIN 50MG T","code_information":[{"code":"2738","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.32,"setting":"both","billing_class":"facility"}]},{"description":"PRIMIDONE 250MG T","code_information":[{"code":"2739","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":1.48,"setting":"both","billing_class":"facility"}]},{"description":"PRIMIDONE 50MG T","code_information":[{"code":"2741","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.85,"setting":"both","billing_class":"facility"}]},{"description":"TEMAZEPAM 15MG C","code_information":[{"code":"2743","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.13,"setting":"both","billing_class":"facility"}]},{"description":"THIORIDAZ 10MG T","code_information":[{"code":"2744","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility"}]},{"description":"THIORIDAZ 25MG T","code_information":[{"code":"2746","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.18,"setting":"both","billing_class":"facility"}]},{"description":"THIOTHIXENE 2MG C","code_information":[{"code":"2750","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"TRAZODONE 50MG T","code_information":[{"code":"2752","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":1.02,"setting":"both","billing_class":"facility"}]},{"description":"TRIFLUOPER 5MG T","code_information":[{"code":"2755","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.38,"setting":"both","billing_class":"facility"}]},{"description":"TRIHEXYPHN 2MG T","code_information":[{"code":"2756","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"DIVALPROEX 250 ECT","code_information":[{"code":"2762","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":1.02,"setting":"both","billing_class":"facility"}]},{"description":"BUPROPION 75MG T","code_information":[{"code":"2766","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"BUSPIRONE 5MG T","code_information":[{"code":"2767","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"FLUOXETINE 20MG C","code_information":[{"code":"2768","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":2.5,"setting":"both","billing_class":"facility"}]},{"description":"FLUOXETINE 10 MG C","code_information":[{"code":"2769","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.48,"setting":"both","billing_class":"facility"}]},{"description":"BUPROPION 100MG T","code_information":[{"code":"2772","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.65,"discounted_cash":1.83,"setting":"both","billing_class":"facility"}]},{"description":"SELEGILINE  5MG T","code_information":[{"code":"2774","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":2.08,"setting":"both","billing_class":"facility"}]},{"description":"CLOMIPRAM 25MG C","code_information":[{"code":"2775","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.6,"discounted_cash":12.3,"setting":"both","billing_class":"facility"}]},{"description":"DOXAZOSIN  1MG C","code_information":[{"code":"2782","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"SERTRALINE 50MG T","code_information":[{"code":"2784","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"LITH CARB 450 SRT","code_information":[{"code":"2785","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility"}]},{"description":"LITH CARB 150MG C","code_information":[{"code":"2787","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"PAROXETINE 20MG T","code_information":[{"code":"2788","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":2.55,"setting":"both","billing_class":"facility"}]},{"description":"ZOLPIDEM TAR 5MG T","code_information":[{"code":"2791","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":4.35,"setting":"both","billing_class":"facility"}]},{"description":"RISPERIDONE 1MG T","code_information":[{"code":"2794","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":4.28,"setting":"both","billing_class":"facility"}]},{"description":"VENLAFAX 25MG T","code_information":[{"code":"2796","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.7,"discounted_cash":1.85,"setting":"both","billing_class":"facility"}]},{"description":"GABAPENTIN 100MG C","code_information":[{"code":"2797","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.05,"setting":"both","billing_class":"facility"}]},{"description":"GABAPENTIN 400MG C","code_information":[{"code":"2798","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.5,"setting":"both","billing_class":"facility"}]},{"description":"GABAPENTIN 300MG C","code_information":[{"code":"2799","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.8,"discounted_cash":3.4,"setting":"both","billing_class":"facility"}]},{"description":"IV INF HYDR ADDL HR","code_information":[{"code":"28","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.3,"discounted_cash":26.65,"setting":"both","billing_class":"facility"}]},{"description":"NEFAZOD 100MG T","code_information":[{"code":"2800","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.05,"discounted_cash":4.53,"setting":"both","billing_class":"facility"}]},{"description":"FLUVOXAM 50MG T","code_information":[{"code":"2801","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":2.42,"setting":"both","billing_class":"facility"}]},{"description":"ACETYL 20% 30ML","code_information":[{"code":"2807","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":45.8,"discounted_cash":22.9,"setting":"both","billing_class":"facility"}]},{"description":"ALBUTEROL 2MG T","code_information":[{"code":"2808","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.15,"discounted_cash":7.58,"setting":"both","billing_class":"facility"}]},{"description":"ALBUTEROL 4MG T","code_information":[{"code":"2809","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.55,"discounted_cash":6.28,"setting":"both","billing_class":"facility"}]},{"description":"ATENOLOL 25MG T","code_information":[{"code":"2814","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"BUMETANIDE 1MG T","code_information":[{"code":"2817","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.05,"setting":"both","billing_class":"facility"}]},{"description":"ISRADIPINE 5MG C","code_information":[{"code":"2821","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.3,"discounted_cash":2.15,"setting":"both","billing_class":"facility"}]},{"description":"INDAPAMIDE 2.5MG T","code_information":[{"code":"2823","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.32,"setting":"both","billing_class":"facility"}]},{"description":"ATENOLOL 50MG T","code_information":[{"code":"2826","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility"}]},{"description":"RAMIPRIL 2.5 MG C","code_information":[{"code":"2827","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.7,"discounted_cash":1.85,"setting":"both","billing_class":"facility"}]},{"description":"RAMIPRIL 5MG C","code_information":[{"code":"2828","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":1.4,"setting":"both","billing_class":"facility"}]},{"description":"LYME IGG","code_information":[{"code":"283","type":"CDM"},{"code":"300","type":"RC"},{"code":"86617","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":34.65,"setting":"both","billing_class":"facility"}]},{"description":"PREGABALIN 50MG C","code_information":[{"code":"2832","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.85,"discounted_cash":9.43,"setting":"both","billing_class":"facility"}]},{"description":"NTG SL 0.4MG","code_information":[{"code":"2833","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.2,"discounted_cash":35.1,"setting":"both","billing_class":"facility"}]},{"description":"AMMONIA AR EA INH","code_information":[{"code":"2837","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"CHLORTHAL 25MG T","code_information":[{"code":"2839","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":2.1,"setting":"both","billing_class":"facility"}]},{"description":"LYME IGM","code_information":[{"code":"284","type":"CDM"},{"code":"300","type":"RC"},{"code":"86617","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.3,"discounted_cash":34.65,"setting":"both","billing_class":"facility"}]},{"description":"CLONIDINE 0.1MG T","code_information":[{"code":"2840","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.43,"setting":"both","billing_class":"facility"}]},{"description":"BENAZEPRIL 10MG T","code_information":[{"code":"2843","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":1.48,"setting":"both","billing_class":"facility"}]},{"description":"FOSINOPRIL 10MG T","code_information":[{"code":"2846","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.7,"discounted_cash":1.85,"setting":"both","billing_class":"facility"}]},{"description":"DIGOXIN 0.125MG T","code_information":[{"code":"2849","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":1.73,"setting":"both","billing_class":"facility"}]},{"description":"DIGOXIN 0.25MG T","code_information":[{"code":"2850","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.8,"discounted_cash":1.9,"setting":"both","billing_class":"facility"}]},{"description":"DIGOXIN ELIX 60ML","code_information":[{"code":"2851","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":315.5,"discounted_cash":157.75,"setting":"both","billing_class":"facility"}]},{"description":"DILTIAZEM 30MG T","code_information":[{"code":"2853","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.78,"setting":"both","billing_class":"facility"}]},{"description":"FELODIPINE 5MG 5","code_information":[{"code":"2855","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"DIPYRIDAM 25MG T","code_information":[{"code":"2858","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"QUINAPRIL 10MG T","code_information":[{"code":"2864","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":1.15,"setting":"both","billing_class":"facility"}]},{"description":"FUROSEMIDE 60ML L","code_information":[{"code":"2872","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.88,"setting":"both","billing_class":"facility"}]},{"description":"FUROSEMIDE 20MG T LA","code_information":[{"code":"2873","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":1.07,"setting":"both","billing_class":"facility"}]},{"description":"FUROSEMIDE 40MG T LA","code_information":[{"code":"2874","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"ISOSORB MN 20MG SRT","code_information":[{"code":"2875","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.85,"setting":"both","billing_class":"facility"}]},{"description":"PROMETH 6.25MG/5ML","code_information":[{"code":"2876","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"HYDRALAZ 10 MG T","code_information":[{"code":"2878","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":1.07,"setting":"both","billing_class":"facility"}]},{"description":"HYDRALAZ 25 MG T","code_information":[{"code":"2879","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.43,"setting":"both","billing_class":"facility"}]},{"description":"SIMVASTATIN 5MG T","code_information":[{"code":"2883","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.2,"discounted_cash":2.6,"setting":"both","billing_class":"facility"}]},{"description":"SOTALOL HCL 80MG T","code_information":[{"code":"2889","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.48,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX 1 HR","code_information":[{"code":"29","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":294.1,"discounted_cash":147.05,"setting":"both","billing_class":"facility"}]},{"description":"LORATADINE 10MG T CL","code_information":[{"code":"2900","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility"}]},{"description":"METHYLDOP 250MG T","code_information":[{"code":"2913","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"METOLAZ 2.5MG T","code_information":[{"code":"2916","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.1,"setting":"both","billing_class":"facility"}]},{"description":"METOPROL 50MG T","code_information":[{"code":"2919","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":1.1,"setting":"both","billing_class":"facility"}]},{"description":"MINOXIDIL 10MG T","code_information":[{"code":"2920","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"MINOXIDIL 2.5MG T","code_information":[{"code":"2921","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":1.1,"setting":"both","billing_class":"facility"}]},{"description":"NIFEDIPINE 10MG C","code_information":[{"code":"2923","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.05,"setting":"both","billing_class":"facility"}]},{"description":"NTG 0.4MG/HR TDP","code_information":[{"code":"2924","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"NTG 0.6MG/HR TDP","code_information":[{"code":"2925","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility"}]},{"description":"NTG 0.2MG/HR TDP","code_information":[{"code":"2927","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"NTG 2% OINT 1G","code_information":[{"code":"2929","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":4.35,"setting":"both","billing_class":"facility"}]},{"description":"OXYMET NS 15ML","code_information":[{"code":"2934","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":3.52,"setting":"both","billing_class":"facility"}]},{"description":"PAPAV  150MG TRC","code_information":[{"code":"2935","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.3,"discounted_cash":2.15,"setting":"both","billing_class":"facility"}]},{"description":"GUAIFENESIN 10ML","code_information":[{"code":"2940","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"PINDOLOL 5MG T","code_information":[{"code":"2946","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"PRAZOSIN 1MG C","code_information":[{"code":"2949","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"CWMDP CBC W/O DIFF","code_information":[{"code":"295","type":"CDM"},{"code":"300","type":"RC"},{"code":"85027","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.7,"discounted_cash":23.35,"setting":"both","billing_class":"facility"}]},{"description":"SIMVASTATIN 10MG T","code_information":[{"code":"2952","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":2.55,"setting":"both","billing_class":"facility"}]},{"description":"THEOPH  300MG SRT","code_information":[{"code":"2956","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":3.95,"setting":"both","billing_class":"facility"}]},{"description":"CWMDP MANUAL DIFF","code_information":[{"code":"296","type":"CDM"},{"code":"300","type":"RC"},{"code":"85007","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.55,"discounted_cash":13.28,"setting":"both","billing_class":"facility"}]},{"description":"PROPRAN 10MG T","code_information":[{"code":"2961","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.65,"setting":"both","billing_class":"facility"}]},{"description":"PROPRAN 20MG T","code_information":[{"code":"2962","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"PROPRAN 40MG T","code_information":[{"code":"2963","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.13,"setting":"both","billing_class":"facility"}]},{"description":"PROPRAN 80MG SRC","code_information":[{"code":"2965","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":15.75,"setting":"both","billing_class":"facility"}]},{"description":"PSEUDOFED 30MG T","code_information":[{"code":"2968","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"TUSSIONEX 5ML","code_information":[{"code":"2971","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.95,"discounted_cash":4.97,"setting":"both","billing_class":"facility"}]},{"description":"QUINIDINE 200MG C","code_information":[{"code":"2972","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"QUINIDINE 324 SRT","code_information":[{"code":"2974","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":8.5,"setting":"both","billing_class":"facility"}]},{"description":"SOD CL AER 3ML","code_information":[{"code":"2982","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"SPIRONOLAC 25MGT","code_information":[{"code":"2983","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.78,"setting":"both","billing_class":"facility"}]},{"description":"TERBUTALINE 5MG T","code_information":[{"code":"2986","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.45,"discounted_cash":6.22,"setting":"both","billing_class":"facility"}]},{"description":"THEOPH  100MG SRT","code_information":[{"code":"2989","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.93,"setting":"both","billing_class":"facility"}]},{"description":"THEO 80MG/15ML 15M","code_information":[{"code":"2991","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.75,"discounted_cash":19.38,"setting":"both","billing_class":"facility"}]},{"description":"GUANABENZ 4MG T","code_information":[{"code":"2993","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"BENZON 100MG SRC","code_information":[{"code":"2996","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.35,"discounted_cash":2.17,"setting":"both","billing_class":"facility"}]},{"description":"VERAP 80MG T","code_information":[{"code":"2998","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"PREGABALIN 75MG C","code_information":[{"code":"2999","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.9,"discounted_cash":9.45,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX ADDL HR","code_information":[{"code":"30","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility"}]},{"description":"ACYCL 5% OINT 15G","code_information":[{"code":"3006","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":748.9,"discounted_cash":374.45,"setting":"both","billing_class":"facility"}]},{"description":"AMANTAD 100MG C","code_information":[{"code":"3007","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.7,"discounted_cash":1.85,"setting":"both","billing_class":"facility"}]},{"description":"AMOX 250/5 100ML","code_information":[{"code":"3011","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"AMOX 250MG C","code_information":[{"code":"3013","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.8,"discounted_cash":0.4,"setting":"both","billing_class":"facility"}]},{"description":"AMPICIL 250/5 100ML","code_information":[{"code":"3020","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.43,"setting":"both","billing_class":"facility"}]},{"description":"AMPICIL 250MG C","code_information":[{"code":"3021","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.43,"setting":"both","billing_class":"facility"}]},{"description":"CHLORHEX MW 480ML","code_information":[{"code":"3022","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.7,"discounted_cash":1.85,"setting":"both","billing_class":"facility"}]},{"description":"BACITRAC OINT 15GM","code_information":[{"code":"3025","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":5.63,"setting":"both","billing_class":"facility"}]},{"description":"BACITRACIN OO3.5GM","code_information":[{"code":"3027","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.6,"discounted_cash":109.8,"setting":"both","billing_class":"facility"}]},{"description":"BAC POLY OINT 15G","code_information":[{"code":"3028","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":11.25,"setting":"both","billing_class":"facility"}]},{"description":"CEFACLOR 250/5 75ML","code_information":[{"code":"3033","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.65,"discounted_cash":4.33,"setting":"both","billing_class":"facility"}]},{"description":"CEFADROXIL 500MG C","code_information":[{"code":"3037","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.8,"discounted_cash":3.4,"setting":"both","billing_class":"facility"}]},{"description":"CEPHALEX 250MG C","code_information":[{"code":"3040","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAMY 150MG C","code_information":[{"code":"3048","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":1.15,"setting":"both","billing_class":"facility"}]},{"description":"CLOTRIM CR 1% 15G","code_information":[{"code":"3050","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.55,"discounted_cash":8.78,"setting":"both","billing_class":"facility"}]},{"description":"CLOTRIM V CR 1% 45G","code_information":[{"code":"3051","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.05,"discounted_cash":12.53,"setting":"both","billing_class":"facility"}]},{"description":"DOXYCY 100MG C","code_information":[{"code":"3061","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":5.15,"setting":"both","billing_class":"facility"}]},{"description":"ERYTHRO ES 333MG T","code_information":[{"code":"3064","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.85,"discounted_cash":10.43,"setting":"both","billing_class":"facility"}]},{"description":"ERYTHR BASE 250MG T","code_information":[{"code":"3065","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.65,"discounted_cash":8.32,"setting":"both","billing_class":"facility"}]},{"description":"ERYTH ESS 400/5 5ML","code_information":[{"code":"3072","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.3,"discounted_cash":13.15,"setting":"both","billing_class":"facility"}]},{"description":"ERYTH ESS 400MG  T","code_information":[{"code":"3073","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.4,"discounted_cash":13.7,"setting":"both","billing_class":"facility"}]},{"description":"ETHAMBUTOL 400MG T","code_information":[{"code":"3076","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"GENTAMIC CR/O 15G","code_information":[{"code":"3077","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":123.95,"discounted_cash":61.98,"setting":"both","billing_class":"facility"}]},{"description":"GENTAMIC 00 3.5GM","code_information":[{"code":"3079","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.3,"discounted_cash":30.65,"setting":"both","billing_class":"facility"}]},{"description":"IOD STR LUGOLS APP","code_information":[{"code":"3089","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.35,"discounted_cash":43.17,"setting":"both","billing_class":"facility"}]},{"description":"CLARITHRO 500MGT","code_information":[{"code":"3091","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":5.67,"setting":"both","billing_class":"facility"}]},{"description":"ISONIAZID 300MG T","code_information":[{"code":"3092","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.18,"setting":"both","billing_class":"facility"}]},{"description":"LINDANE LOT 60ML","code_information":[{"code":"3095","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":270.1,"discounted_cash":135.05,"setting":"both","billing_class":"facility"}]},{"description":"LINDANE SH 60ML","code_information":[{"code":"3096","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":257.25,"discounted_cash":128.63,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX SEQ 1HR","code_information":[{"code":"31","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":166.1,"discounted_cash":83.05,"setting":"both","billing_class":"facility"}]},{"description":"METRONID 250MG T","code_information":[{"code":"3102","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":1.02,"setting":"both","billing_class":"facility"}]},{"description":"MICONAZO CR 15GM","code_information":[{"code":"3103","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":3.75,"setting":"both","billing_class":"facility"}]},{"description":"MICONAZO V CR 45GM","code_information":[{"code":"3104","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":28.6,"discounted_cash":14.3,"setting":"both","billing_class":"facility"}]},{"description":"NEOMYCIN 500MG T","code_information":[{"code":"3109","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"AZITHROMY 250MG C","code_information":[{"code":"3110","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":5.75,"setting":"both","billing_class":"facility"}]},{"description":"NEO,BAC,PMX OO 3.5","code_information":[{"code":"3113","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":142.75,"discounted_cash":71.38,"setting":"both","billing_class":"facility"}]},{"description":"NEO PMX GM OS 10ML","code_information":[{"code":"3114","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility"}]},{"description":"NYS,TRIAM CR/O 15GM","code_information":[{"code":"3117","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.3,"discounted_cash":105.15,"setting":"both","billing_class":"facility"}]},{"description":"NYS,TRIA CR/O 15GM","code_information":[{"code":"3118","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":243.4,"discounted_cash":121.7,"setting":"both","billing_class":"facility"}]},{"description":"NEO,PMX GU 1ML","code_information":[{"code":"3119","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.3,"discounted_cash":20.65,"setting":"both","billing_class":"facility"}]},{"description":"NEO,PMX,HC OT 10ML","code_information":[{"code":"3120","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":233.2,"discounted_cash":116.6,"setting":"both","billing_class":"facility"}]},{"description":"NITROFURANT 100MG C","code_information":[{"code":"3122","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.45,"discounted_cash":3.23,"setting":"both","billing_class":"facility"}]},{"description":"NITROFUR 50MG C","code_information":[{"code":"3123","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.15,"discounted_cash":2.58,"setting":"both","billing_class":"facility"}]},{"description":"NYSTATIN 5ML","code_information":[{"code":"3127","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":1.4,"setting":"both","billing_class":"facility"}]},{"description":"NYSTATIN CR/O 15GM","code_information":[{"code":"3129","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.05,"discounted_cash":27.52,"setting":"both","billing_class":"facility"}]},{"description":"NYSTATIN PWD 15GM","code_information":[{"code":"3130","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":68.9,"discounted_cash":34.45,"setting":"both","billing_class":"facility"}]},{"description":"ITRACON 100MG C","code_information":[{"code":"3133","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.4,"discounted_cash":31.7,"setting":"both","billing_class":"facility"}]},{"description":"PEN VK 125/5 100ML","code_information":[{"code":"3134","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"PEN VK 250MG T","code_information":[{"code":"3136","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":1.15,"setting":"both","billing_class":"facility"}]},{"description":"TOBRAMYCN OO 3.5GM","code_information":[{"code":"3137","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.25,"discounted_cash":241.63,"setting":"both","billing_class":"facility"}]},{"description":"NEO BAC P HC OO3.5","code_information":[{"code":"3138","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":162.75,"discounted_cash":81.38,"setting":"both","billing_class":"facility"}]},{"description":"POV-IOD 10% 30G","code_information":[{"code":"3142","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.95,"discounted_cash":4.97,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAMY 2% CR 40G","code_information":[{"code":"3147","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":244.75,"discounted_cash":122.38,"setting":"both","billing_class":"facility"}]},{"description":"KETOROL 0.5% OS","code_information":[{"code":"3148","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":198.85,"discounted_cash":99.42,"setting":"both","billing_class":"facility"}]},{"description":"RIFAMPIN 300MG C","code_information":[{"code":"3150","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.7,"discounted_cash":1.85,"setting":"both","billing_class":"facility"}]},{"description":"SILVER SD 25G CR","code_information":[{"code":"3152","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":14.25,"setting":"both","billing_class":"facility"}]},{"description":"SILVER SD 400G CR","code_information":[{"code":"3153","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":177.15,"discounted_cash":88.58,"setting":"both","billing_class":"facility"}]},{"description":"SULFAC OS 10% 15ML","code_information":[{"code":"3157","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":152.7,"discounted_cash":76.35,"setting":"both","billing_class":"facility"}]},{"description":"SULFASALA 500MG T","code_information":[{"code":"3162","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.53,"setting":"both","billing_class":"facility"}]},{"description":"TETRACYCL 250MG C","code_information":[{"code":"3167","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"TOBRAMY OS 0.3% 5","code_information":[{"code":"3168","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":229.9,"discounted_cash":114.95,"setting":"both","billing_class":"facility"}]},{"description":"TOLNAFT 1% CR 15GM","code_information":[{"code":"3169","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":4.35,"setting":"both","billing_class":"facility"}]},{"description":"TRIMETHOPR 100MG T","code_information":[{"code":"3173","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"TRIM,SULF 400/80 T","code_information":[{"code":"3174","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"TRIM/SULF 200/40 5ML","code_information":[{"code":"3175","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":3.5,"setting":"both","billing_class":"facility"}]},{"description":"TRIM,SULF 800/160 T","code_information":[{"code":"3176","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":1.15,"setting":"both","billing_class":"facility"}]},{"description":"CLOTRIMA BT 10MG","code_information":[{"code":"3178","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":1.4,"setting":"both","billing_class":"facility"}]},{"description":"NEO PMX DEX OS 5ML","code_information":[{"code":"3179","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.15,"discounted_cash":55.08,"setting":"both","billing_class":"facility"}]},{"description":"ERYTH OO 3.5G","code_information":[{"code":"3184","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.15,"discounted_cash":29.07,"setting":"both","billing_class":"facility"}]},{"description":"AMOX,KCLAV 500T","code_information":[{"code":"3190","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility"}]},{"description":"ACYCLOVIR 200MG C","code_information":[{"code":"3196","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"KETOCON CR 2% 15G","code_information":[{"code":"3199","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.6,"discounted_cash":38.8,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX CONCRNT","code_information":[{"code":"32","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.15,"discounted_cash":47.58,"setting":"both","billing_class":"facility"}]},{"description":"FAMCICLOVIR 500 T","code_information":[{"code":"3206","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.8,"discounted_cash":11.9,"setting":"both","billing_class":"facility"}]},{"description":"CIPROFLOX 250MG T","code_information":[{"code":"3207","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.95,"discounted_cash":4.97,"setting":"both","billing_class":"facility"}]},{"description":"CIPROFLOX 500MG T","code_information":[{"code":"3208","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":3.42,"setting":"both","billing_class":"facility"}]},{"description":"CEFUROX AX 25O T","code_information":[{"code":"3210","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.2,"discounted_cash":4.1,"setting":"both","billing_class":"facility"}]},{"description":"ALUM OH GEL 30ML","code_information":[{"code":"3213","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"GAVISCON TAB","code_information":[{"code":"3215","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"ANUSOL OINT 30GM","code_information":[{"code":"3232","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":7.25,"setting":"both","billing_class":"facility"}]},{"description":"BISACODYL 5MG T","code_information":[{"code":"3236","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"BISACODYL SUPP 10MG","code_information":[{"code":"3237","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"BISMUTH SUBS 30ML","code_information":[{"code":"3239","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.95,"discounted_cash":4.97,"setting":"both","billing_class":"facility"}]},{"description":"PREPARATION H OINT","code_information":[{"code":"3246","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":10.63,"setting":"both","billing_class":"facility"}]},{"description":"CHLORD,CLID C","code_information":[{"code":"3248","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":4.83,"setting":"both","billing_class":"facility"}]},{"description":"CIMETIDINE 300MG T","code_information":[{"code":"3250","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.8,"discounted_cash":1.9,"setting":"both","billing_class":"facility"}]},{"description":"DICYCLOMINE 10MG C","code_information":[{"code":"3252","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":1.15,"setting":"both","billing_class":"facility"}]},{"description":"DICYCLOM 10/5 5ML","code_information":[{"code":"3253","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility"}]},{"description":"PREPARATION H SUPP","code_information":[{"code":"3256","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":3.42,"setting":"both","billing_class":"facility"}]},{"description":"DIPHEN,ATR 2.5/0.025","code_information":[{"code":"3257","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"DOCUSATE  100MG C","code_information":[{"code":"3261","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"GLYCERIN RS ADULT","code_information":[{"code":"3268","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.43,"setting":"both","billing_class":"facility"}]},{"description":"GLYCERIN RS CHILD","code_information":[{"code":"3269","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.18,"setting":"both","billing_class":"facility"}]},{"description":"HYOSCY 0.125MG SLT","code_information":[{"code":"3273","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.53,"setting":"both","billing_class":"facility"}]},{"description":"HYOSCY 0.375MG SRC","code_information":[{"code":"3274","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":1.52,"setting":"both","billing_class":"facility"}]},{"description":"LACTULOSE 30ML","code_information":[{"code":"3285","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"LOPERAMIDE 2MG C","code_information":[{"code":"3286","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility"}]},{"description":"MAG CITRATE 300ML","code_information":[{"code":"3287","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"MAG OXIDE 400MG T","code_information":[{"code":"3288","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"MECLIZINE 12.5MG T","code_information":[{"code":"3291","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"MECLIZINE 25MG T","code_information":[{"code":"3292","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"METOCLOPR 10MG T","code_information":[{"code":"3293","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.53,"setting":"both","billing_class":"facility"}]},{"description":"MILK OF MAG 30ML","code_information":[{"code":"3294","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.1,"discounted_cash":2.05,"setting":"both","billing_class":"facility"}]},{"description":"MINERAL OIL 30ML","code_information":[{"code":"3296","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.18,"setting":"both","billing_class":"facility"}]},{"description":"MINERAL OIL ST 25ML","code_information":[{"code":"3297","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.9,"discounted_cash":8.45,"setting":"both","billing_class":"facility"}]},{"description":"OXYBUTYNIN 5MG T","code_information":[{"code":"3299","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.18,"setting":"both","billing_class":"facility"}]},{"description":"INJ IM/SQ","code_information":[{"code":"33","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":53.88,"setting":"both","billing_class":"facility"}]},{"description":"PAREGORIC 5ML","code_information":[{"code":"3302","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility"}]},{"description":"PROCHLORP 10MG T","code_information":[{"code":"3305","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":1.43,"setting":"both","billing_class":"facility"}]},{"description":"PROMETH RS 12.5 MG","code_information":[{"code":"3308","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":16.63,"setting":"both","billing_class":"facility"}]},{"description":"PROMETH RS 25MG","code_information":[{"code":"3309","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":16.75,"setting":"both","billing_class":"facility"}]},{"description":"SENNA CONC,DOC T","code_information":[{"code":"3314","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"SIMETHICONE 80MG T","code_information":[{"code":"3315","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.53,"setting":"both","billing_class":"facility"}]},{"description":"SIMETH 120/1.8 30ML","code_information":[{"code":"3316","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"SOD BICARB 650MG T","code_information":[{"code":"3317","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.48,"setting":"both","billing_class":"facility"}]},{"description":"PROCHLORP RS 25MG","code_information":[{"code":"3318","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.6,"discounted_cash":13.8,"setting":"both","billing_class":"facility"}]},{"description":"SUCRALFATE 1GM T","code_information":[{"code":"3320","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.65,"setting":"both","billing_class":"facility"}]},{"description":"RANITIDINE 150MG","code_information":[{"code":"3329","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0173","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":1.63,"setting":"both","billing_class":"facility"}]},{"description":"METOCLOPR10MG/10ML","code_information":[{"code":"3335","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0173","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.1,"discounted_cash":2.05,"setting":"both","billing_class":"facility"}]},{"description":"CHARC/SORB 50GM","code_information":[{"code":"3336","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0173","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.7,"discounted_cash":29.85,"setting":"both","billing_class":"facility"}]},{"description":"FAMOTIDINE 20MG T","code_information":[{"code":"3339","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0173","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":1.73,"setting":"both","billing_class":"facility"}]},{"description":"MISOPROS 200MCG T","code_information":[{"code":"3341","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0173","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility"}]},{"description":"CHOLES LITE 4GM PK","code_information":[{"code":"3342","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0173","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.7,"discounted_cash":4.85,"setting":"both","billing_class":"facility"}]},{"description":"OMEPRAZOL 20MG C","code_information":[{"code":"3344","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0173","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.65,"discounted_cash":4.33,"setting":"both","billing_class":"facility"}]},{"description":"SUCRAL SUSP 1GM/10ML","code_information":[{"code":"3350","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0173","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":2.85,"setting":"both","billing_class":"facility"}]},{"description":"HYDROXYUR 500MG C","code_information":[{"code":"3352","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility"}]},{"description":"MERCAPTOP 50MG T","code_information":[{"code":"3355","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.45,"discounted_cash":7.72,"setting":"both","billing_class":"facility"}]},{"description":"TAMOXIFEN 10MG T","code_information":[{"code":"3358","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":1.8,"setting":"both","billing_class":"facility"}]},{"description":"AZATHIOPRIN 50MG T","code_information":[{"code":"3361","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":2.27,"setting":"both","billing_class":"facility"}]},{"description":"LEUCOVORIN 5MG T","code_information":[{"code":"3362","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.4,"discounted_cash":2.2,"setting":"both","billing_class":"facility"}]},{"description":"FLUOROURACIL CR 5%","code_information":[{"code":"3364","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":533.3,"discounted_cash":266.65,"setting":"both","billing_class":"facility"}]},{"description":"FLUTAMIDE 125MG C","code_information":[{"code":"3367","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.35,"discounted_cash":4.67,"setting":"both","billing_class":"facility"}]},{"description":"BETAXO OS 0.5% 5ML","code_information":[{"code":"3372","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":165.9,"discounted_cash":82.95,"setting":"both","billing_class":"facility"}]},{"description":"CHONDR/HYAL 0.5ML","code_information":[{"code":"3374","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":323.6,"discounted_cash":161.8,"setting":"both","billing_class":"facility"}]},{"description":"LEVOBUNO OS 0.5%5ML","code_information":[{"code":"3376","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.55,"discounted_cash":8.78,"setting":"both","billing_class":"facility"}]},{"description":"ETOPOSIDE 1GM/50ML J","code_information":[{"code":"3383","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.84,"discounted_cash":2.92,"setting":"both","billing_class":"facility"}]},{"description":"LOVASTATIN 20MG T","code_information":[{"code":"3384","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.4,"discounted_cash":2.2,"setting":"both","billing_class":"facility"}]},{"description":"MESALAM 4GM/60ML EN","code_information":[{"code":"3388","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.7,"discounted_cash":30.35,"setting":"both","billing_class":"facility"}]},{"description":"URSODIOL 300MG C","code_information":[{"code":"3389","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"PERMETH 5% CR 60G","code_information":[{"code":"3393","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":222.85,"discounted_cash":111.42,"setting":"both","billing_class":"facility"}]},{"description":"MESALAMINE RS 1000MG","code_information":[{"code":"3394","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.25,"discounted_cash":43.63,"setting":"both","billing_class":"facility"}]},{"description":"PRAVASTATIN 10MG T","code_information":[{"code":"3396","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":2.73,"setting":"both","billing_class":"facility"}]},{"description":"CAPSAICIN 0.075% 60G","code_information":[{"code":"3398","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.3,"discounted_cash":20.65,"setting":"both","billing_class":"facility"}]},{"description":"MESALAMINE 400MG T","code_information":[{"code":"3399","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.35,"discounted_cash":4.17,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP SGL/INT SUBS","code_information":[{"code":"34","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":278.95,"discounted_cash":139.47,"setting":"both","billing_class":"facility"}]},{"description":"BETAM DIP 0.05OI 15G","code_information":[{"code":"3407","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.95,"discounted_cash":79.47,"setting":"both","billing_class":"facility"}]},{"description":"DESOXIMET 0.25%CR 15","code_information":[{"code":"3419","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":190.3,"discounted_cash":95.15,"setting":"both","billing_class":"facility"}]},{"description":"DEXAMETH 0.5MG T","code_information":[{"code":"3420","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.46,"discounted_cash":0.23,"setting":"both","billing_class":"facility"}]},{"description":"DEXAMETH 4MG T","code_information":[{"code":"3423","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.1,"discounted_cash":0.05,"setting":"both","billing_class":"facility"}]},{"description":"DEXAMETH OS 5ML","code_information":[{"code":"3426","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":162.1,"discounted_cash":81.05,"setting":"both","billing_class":"facility"}]},{"description":"FLUDROCOR 0.1MG T","code_information":[{"code":"3431","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"IBUPROFEN 600MG T","code_information":[{"code":"3448","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.65,"setting":"both","billing_class":"facility"}]},{"description":"INDOMETH 25MG C","code_information":[{"code":"3449","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPRED 4MG T","code_information":[{"code":"3454","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility"}]},{"description":"NAPROXEN 250MG T","code_information":[{"code":"3455","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"NAPROXEN 375MG T","code_information":[{"code":"3457","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"NAPROXEN 500MG T","code_information":[{"code":"3458","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"PIROXICAM 20MG C","code_information":[{"code":"3460","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":4.83,"setting":"both","billing_class":"facility"}]},{"description":"PREDNIS OS 1% 5ML","code_information":[{"code":"3462","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.05,"discounted_cash":105.03,"setting":"both","billing_class":"facility"}]},{"description":"PREDNISONE 10MG TAB","code_information":[{"code":"3464","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.1,"discounted_cash":0.05,"setting":"both","billing_class":"facility"}]},{"description":"PREDNISONE 20 MG TAB","code_information":[{"code":"3465","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.03,"setting":"both","billing_class":"facility"}]},{"description":"PREDNISONE 50MG T","code_information":[{"code":"3466","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.75,"setting":"both","billing_class":"facility"}]},{"description":"PREDNISONE 5 MG TAB","code_information":[{"code":"3467","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.11,"setting":"both","billing_class":"facility"}]},{"description":"PREDNISONE 5/5 5ML","code_information":[{"code":"3468","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":1.28,"setting":"both","billing_class":"facility"}]},{"description":"SALSALATE 750MG T","code_information":[{"code":"3469","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":2.55,"setting":"both","billing_class":"facility"}]},{"description":"SULINDAC 150MG T","code_information":[{"code":"3470","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"SULINDAC 200MG T","code_information":[{"code":"3471","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.13,"setting":"both","billing_class":"facility"}]},{"description":"TRIAMCIN CR 0.1% 15","code_information":[{"code":"3476","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.55,"discounted_cash":8.78,"setting":"both","billing_class":"facility"}]},{"description":"TRIAM,DENTAL 5GM","code_information":[{"code":"3477","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":201.55,"discounted_cash":100.78,"setting":"both","billing_class":"facility"}]},{"description":"IBUPROFEN 200MG T","code_information":[{"code":"3480","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.8,"discounted_cash":0.4,"setting":"both","billing_class":"facility"}]},{"description":"IBUPROFEN 800MG T","code_information":[{"code":"3483","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"FLURBIP .03%OS 2.5ML","code_information":[{"code":"3489","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":54.13,"setting":"both","billing_class":"facility"}]},{"description":"PREDNISO 15MG/5ML","code_information":[{"code":"3491","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"FLUOROM OS 0.1% 10ML","code_information":[{"code":"3493","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":344.3,"discounted_cash":172.15,"setting":"both","billing_class":"facility"}]},{"description":"DICLOFEN SOD 50MGT","code_information":[{"code":"3495","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.32,"setting":"both","billing_class":"facility"}]},{"description":"DICLOFEN SOD 75MGT","code_information":[{"code":"3496","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":1.73,"setting":"both","billing_class":"facility"}]},{"description":"IBUPROFEN 20/M 120ML","code_information":[{"code":"3499","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.43,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP ADD/SEQ SUBS","code_information":[{"code":"35","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.5,"discounted_cash":79.25,"setting":"both","billing_class":"facility"}]},{"description":"IBUPROFEN 20/ML 5ML","code_information":[{"code":"3500","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"NABUMETONE 500MG T","code_information":[{"code":"3504","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"ASC AC 500MG T","code_information":[{"code":"3512","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.48,"setting":"both","billing_class":"facility"}]},{"description":"GLYBURIDE 3MG T","code_information":[{"code":"3514","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility"}]},{"description":"FINASTERIDE 5MG T","code_information":[{"code":"3517","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.05,"discounted_cash":3.02,"setting":"both","billing_class":"facility"}]},{"description":"CALCITRIOL 0.25MCG C","code_information":[{"code":"3528","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.18,"setting":"both","billing_class":"facility"}]},{"description":"CHLORPROP 250 MG T","code_information":[{"code":"3531","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":2.85,"setting":"both","billing_class":"facility"}]},{"description":"GLIPIZIDE XL 5MG SRT","code_information":[{"code":"3537","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"ENSURE 240ML","code_information":[{"code":"3538","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"ENSURE ENLIVE 240ML","code_information":[{"code":"3540","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"ESTRADIOL 1MG T","code_information":[{"code":"3541","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"ESTR CONJ 0.3MG T","code_information":[{"code":"3542","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.65,"discounted_cash":6.33,"setting":"both","billing_class":"facility"}]},{"description":"ESTR CONJ 0.625MG T","code_information":[{"code":"3543","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.2,"discounted_cash":6.1,"setting":"both","billing_class":"facility"}]},{"description":"ESTROGENS V CR 45GM","code_information":[{"code":"3546","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":841.95,"discounted_cash":420.98,"setting":"both","billing_class":"facility"}]},{"description":"ESTROP 0.625MG T","code_information":[{"code":"3550","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"FOLIC ACID 1MG T","code_information":[{"code":"3563","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.65,"setting":"both","billing_class":"facility"}]},{"description":"LEVOTHYROX 0.05MG T","code_information":[{"code":"3565","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.78,"setting":"both","billing_class":"facility"}]},{"description":"LEVOTHYROX 0.1MG T","code_information":[{"code":"3566","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility"}]},{"description":"LIOTHYRON 25MCG C","code_information":[{"code":"3568","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"MEDROXYPR 2.5MGT","code_information":[{"code":"3571","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.6,"setting":"both","billing_class":"facility"}]},{"description":"MEGESTR AC 40MG T","code_information":[{"code":"3572","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"METHIMA 10MG T","code_information":[{"code":"3573","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"METHYLERGON 0.2MGT","code_information":[{"code":"3574","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":140.2,"discounted_cash":70.1,"setting":"both","billing_class":"facility"}]},{"description":"NIACIN 100MG T","code_information":[{"code":"3581","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"POTASSIUM CL 10MEQ T","code_information":[{"code":"3587","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"POT CL EFF 25MEQ T","code_information":[{"code":"3590","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility"}]},{"description":"OYS CAL  500T","code_information":[{"code":"3591","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.48,"setting":"both","billing_class":"facility"}]},{"description":"PROPYLTHIOUR 50MG","code_information":[{"code":"3593","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":1.4,"setting":"both","billing_class":"facility"}]},{"description":"ADMIN INFLUENZA VACC","code_information":[{"code":"36","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.84,"discounted_cash":36.42,"setting":"both","billing_class":"facility"}]},{"description":"THIAMINE 100MG T","code_information":[{"code":"3603","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.48,"setting":"both","billing_class":"facility"}]},{"description":"THYROID 60MG T","code_information":[{"code":"3606","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":1.55,"setting":"both","billing_class":"facility"}]},{"description":"VIT E 400U C","code_information":[{"code":"3618","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.48,"setting":"both","billing_class":"facility"}]},{"description":"GLYBURIDE 2.5MG T","code_information":[{"code":"3621","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.75,"setting":"both","billing_class":"facility"}]},{"description":"GLYBURIDE 5MG T","code_information":[{"code":"3622","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"GLIPIZIDE 5MG T","code_information":[{"code":"3627","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.65,"setting":"both","billing_class":"facility"}]},{"description":"TRINSICON CAP","code_information":[{"code":"3633","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.8,"setting":"both","billing_class":"facility"}]},{"description":"K P04 NEU 250/278/16","code_information":[{"code":"3634","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":1.15,"setting":"both","billing_class":"facility"}]},{"description":"PRENATAL VIT W/ FE","code_information":[{"code":"3638","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.48,"setting":"both","billing_class":"facility"}]},{"description":"ESTRADIOL TDP 0.05MG","code_information":[{"code":"3644","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.25,"discounted_cash":43.13,"setting":"both","billing_class":"facility"}]},{"description":"ESTRADIOL TDP 0.1MG","code_information":[{"code":"3645","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.25,"discounted_cash":43.13,"setting":"both","billing_class":"facility"}]},{"description":"MAG CL EL 64MG SRT","code_information":[{"code":"3649","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"LEVOTHYROX 0.112MG","code_information":[{"code":"3651","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.32,"setting":"both","billing_class":"facility"}]},{"description":"GLUCERNA 240ML","code_information":[{"code":"3652","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"SUPLENA 240ML","code_information":[{"code":"3654","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.95,"discounted_cash":4.97,"setting":"both","billing_class":"facility"}]},{"description":"SOD CL INH 0.9% 4ML","code_information":[{"code":"3657","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":1.22,"setting":"both","billing_class":"facility"}]},{"description":"CALCIUM ACE 667MG T","code_information":[{"code":"3660","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility"}]},{"description":"NEPRO 1L","code_information":[{"code":"3661","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.7,"discounted_cash":35.35,"setting":"both","billing_class":"facility"}]},{"description":"LEVOTHROX 0.088MG","code_information":[{"code":"3663","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":1.15,"setting":"both","billing_class":"facility"}]},{"description":"PHYTONADIONE 5MG T","code_information":[{"code":"3665","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":132.5,"discounted_cash":66.25,"setting":"both","billing_class":"facility"}]},{"description":"THROMBIN TOP 5000U","code_information":[{"code":"3667","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":215.35,"discounted_cash":107.67,"setting":"both","billing_class":"facility"}]},{"description":"WARFARIN SOD 10MG T","code_information":[{"code":"3668","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.4,"discounted_cash":3.7,"setting":"both","billing_class":"facility"}]},{"description":"WARFARIN SOD 2.5MG T","code_information":[{"code":"3669","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":2.5,"setting":"both","billing_class":"facility"}]},{"description":"WARFARIN SOD 2MG T","code_information":[{"code":"3670","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.45,"setting":"both","billing_class":"facility"}]},{"description":"WARFARIN SOD 5MG T","code_information":[{"code":"3671","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":2.55,"setting":"both","billing_class":"facility"}]},{"description":"WARFARIN SOD 7.5MG T","code_information":[{"code":"3672","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":3.63,"setting":"both","billing_class":"facility"}]},{"description":"VERAPAMIL 240MG SRT","code_information":[{"code":"3677","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.48,"setting":"both","billing_class":"facility"}]},{"description":"LABETALOL 100MG T","code_information":[{"code":"3678","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.05,"setting":"both","billing_class":"facility"}]},{"description":"ALBUTEROL 4MG SRT","code_information":[{"code":"3679","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":1.65,"setting":"both","billing_class":"facility"}]},{"description":"LIDO 2% JELLY 5GM","code_information":[{"code":"3684","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.1,"discounted_cash":12.55,"setting":"both","billing_class":"facility"}]},{"description":"ALBUTEROL 0.083 3ML","code_information":[{"code":"3685","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"LABETALOL 300MG T","code_information":[{"code":"3687","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":1.4,"setting":"both","billing_class":"facility"}]},{"description":"DIPHENHY 12.5/5 5ML","code_information":[{"code":"3689","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"PENTOXIFY 400MG SRT","code_information":[{"code":"3692","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.65,"discounted_cash":3.33,"setting":"both","billing_class":"facility"}]},{"description":"ADMIN PNEUMO VACC","code_information":[{"code":"37","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.46,"discounted_cash":36.73,"setting":"both","billing_class":"facility"}]},{"description":"CAPTOPRIL 12.5MG T","code_information":[{"code":"3701","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":1.63,"setting":"both","billing_class":"facility"}]},{"description":"ACEBUTOLOL 200MG C","code_information":[{"code":"3703","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":1.55,"setting":"both","billing_class":"facility"}]},{"description":"CLONIDINE TTS-1 TDP","code_information":[{"code":"3706","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.6,"discounted_cash":41.3,"setting":"both","billing_class":"facility"}]},{"description":"CLONIDINE TTS-2 TDP","code_information":[{"code":"3707","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":139.7,"discounted_cash":69.85,"setting":"both","billing_class":"facility"}]},{"description":"ALBUTEROL 2/5 5ML","code_information":[{"code":"3709","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"AMIODARONE 200MG T","code_information":[{"code":"3710","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.18,"setting":"both","billing_class":"facility"}]},{"description":"FLECAINIDE 100MG T","code_information":[{"code":"3711","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":5.63,"setting":"both","billing_class":"facility"}]},{"description":"ENALAPRIL 10MG T","code_information":[{"code":"3714","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":1.52,"setting":"both","billing_class":"facility"}]},{"description":"MEXILETINE 200MG C","code_information":[{"code":"3717","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"GUAIFEN 600MG SRT","code_information":[{"code":"3721","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.73,"setting":"both","billing_class":"facility"}]},{"description":"ALBUTEROL HFA 90MCG","code_information":[{"code":"3722","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"NTG TDP 0.3MG/HR","code_information":[{"code":"3723","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.8,"discounted_cash":29.4,"setting":"both","billing_class":"facility"}]},{"description":"BISOPRO,HCTZ 5/6.25","code_information":[{"code":"3724","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"IPRATROP 18MCG AER","code_information":[{"code":"3725","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":874.6,"discounted_cash":437.3,"setting":"both","billing_class":"facility"}]},{"description":"GUANFACINE 1MG T","code_information":[{"code":"3726","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.32,"setting":"both","billing_class":"facility"}]},{"description":"PROPRAN  60MG SRC","code_information":[{"code":"3728","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.8,"discounted_cash":1.9,"setting":"both","billing_class":"facility"}]},{"description":"IPRATROP HFA 17 MCG","code_information":[{"code":"3729","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"TERAZOSIN 1MG T","code_information":[{"code":"3730","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":1.48,"setting":"both","billing_class":"facility"}]},{"description":"TERAZOSIN 5MG T","code_information":[{"code":"3732","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"LISINOPRIL 5MG T","code_information":[{"code":"3733","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.32,"setting":"both","billing_class":"facility"}]},{"description":"LISINOPRIL 10MG T","code_information":[{"code":"3734","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"TRIAM HCTZ 37.5/25 T","code_information":[{"code":"3737","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.65,"setting":"both","billing_class":"facility"}]},{"description":"GEMFIBROZIL 600MG T","code_information":[{"code":"3738","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.1,"setting":"both","billing_class":"facility"}]},{"description":"DILTIAZEM 120MG SRC","code_information":[{"code":"3741","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.13,"setting":"both","billing_class":"facility"}]},{"description":"NIMODIPINE 30MG C","code_information":[{"code":"3746","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.05,"discounted_cash":17.52,"setting":"both","billing_class":"facility"}]},{"description":"NIFEDIPINE 30MG SRT","code_information":[{"code":"3747","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"IEUP UR IFE W/CONC","code_information":[{"code":"375","type":"CDM"},{"code":"302","type":"RC"},{"code":"86335","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.6,"discounted_cash":65.3,"setting":"both","billing_class":"facility"}]},{"description":"VERAPAMIL 180 SRT","code_information":[{"code":"3750","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.45,"setting":"both","billing_class":"facility"}]},{"description":"METRONID V GEL 0.75","code_information":[{"code":"3751","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":286.65,"discounted_cash":143.32,"setting":"both","billing_class":"facility"}]},{"description":"WARFARIN SOD 1MG T","code_information":[{"code":"3753","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.35,"setting":"both","billing_class":"facility"}]},{"description":"DILTIAZEM 180 SRT","code_information":[{"code":"3754","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.75,"setting":"both","billing_class":"facility"}]},{"description":"DILTIAZEM 240 SRT","code_information":[{"code":"3755","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"DILTIAZEM  300MG SRC","code_information":[{"code":"3757","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":2.85,"setting":"both","billing_class":"facility"}]},{"description":"TICLOPIDINE 250MG T","code_information":[{"code":"3758","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":1.95,"setting":"both","billing_class":"facility"}]},{"description":"IEPS IGA/IGG/IGM EA","code_information":[{"code":"376","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.35,"discounted_cash":18.18,"setting":"both","billing_class":"facility"}]},{"description":"AMLODIPINE 5MG T","code_information":[{"code":"3760","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":1.73,"setting":"both","billing_class":"facility"}]},{"description":"WARFARIN SOD 4MG T","code_information":[{"code":"3763","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":2.5,"setting":"both","billing_class":"facility"}]},{"description":"TORSEMIDE 20MG T","code_information":[{"code":"3766","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"ACETAZOLAM 250MG T","code_information":[{"code":"3768","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"ACETAZOLAM 500MG C","code_information":[{"code":"3770","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":4.6,"setting":"both","billing_class":"facility"}]},{"description":"MIOCHOL E 1:100 OS 2","code_information":[{"code":"3771","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":222.85,"discounted_cash":111.42,"setting":"both","billing_class":"facility"}]},{"description":"ALUM AC 25% TS PKT","code_information":[{"code":"3773","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"SCOP HBR 0.25 OS 5ML","code_information":[{"code":"3774","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.95,"discounted_cash":55.98,"setting":"both","billing_class":"facility"}]},{"description":"TINC BENZ SPRAY APP","code_information":[{"code":"3775","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"EUCERIN CR 120G","code_information":[{"code":"3776","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.9,"discounted_cash":9.95,"setting":"both","billing_class":"facility"}]},{"description":"NICOTINE 21MG TDP","code_information":[{"code":"3777","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility"}]},{"description":"ATROP OS 1% 5ML","code_information":[{"code":"3779","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":146.45,"discounted_cash":73.22,"setting":"both","billing_class":"facility"}]},{"description":"IEPS IFE SERUM","code_information":[{"code":"378","type":"CDM"},{"code":"300","type":"RC"},{"code":"86334","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":93.35,"discounted_cash":46.67,"setting":"both","billing_class":"facility"}]},{"description":"NICOTINE 7MG TDP","code_information":[{"code":"3780","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":3.5,"setting":"both","billing_class":"facility"}]},{"description":"NICOTINE 14MG TDP","code_information":[{"code":"3781","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility"}]},{"description":"BENZOIN  CT PER APP","code_information":[{"code":"3782","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.9,"discounted_cash":8.45,"setting":"both","billing_class":"facility"}]},{"description":"BETHANECHOL 10MG T","code_information":[{"code":"3784","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"BETHANECHOL 25MG T","code_information":[{"code":"3785","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.55,"discounted_cash":6.28,"setting":"both","billing_class":"facility"}]},{"description":"BSS OS 15ML","code_information":[{"code":"3788","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":14.88,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP SAME SUBS","code_information":[{"code":"38","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":183.8,"discounted_cash":91.9,"setting":"both","billing_class":"facility"}]},{"description":"CYCLOPEN OS 1%2ML","code_information":[{"code":"3804","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":51.35,"discounted_cash":25.68,"setting":"both","billing_class":"facility"}]},{"description":"CYPROHEP 4MG T","code_information":[{"code":"3807","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility"}]},{"description":"DACRIOSE OS 30ML","code_information":[{"code":"3810","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.05,"discounted_cash":27.52,"setting":"both","billing_class":"facility"}]},{"description":"DMSO 50% 50ML TS","code_information":[{"code":"3813","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1212","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1313.95,"discounted_cash":656.98,"setting":"both","billing_class":"facility"}]},{"description":"DINOPROS 10MG VS","code_information":[{"code":"3814","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1212","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.75,"discounted_cash":430.38,"setting":"both","billing_class":"facility"}]},{"description":"DIPHENH 25MG C","code_information":[{"code":"3817","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1212","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.63,"setting":"both","billing_class":"facility"}]},{"description":"FLUORESC STRIP EA","code_information":[{"code":"3830","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1212","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.53,"setting":"both","billing_class":"facility"}]},{"description":"METHAZOLA 50MG T","code_information":[{"code":"3839","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1212","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.45,"discounted_cash":7.22,"setting":"both","billing_class":"facility"}]},{"description":"FERSS (MONSEL) 30ML","code_information":[{"code":"3841","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1212","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"FLAVOXATE 100MG T","code_information":[{"code":"3842","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1212","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"NAPH PHENIR OS 15ML","code_information":[{"code":"3845","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1212","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":28.15,"discounted_cash":14.07,"setting":"both","billing_class":"facility"}]},{"description":"RAVULIZUMAB CWVZ 300","code_information":[{"code":"3847","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":435.57,"discounted_cash":217.78,"setting":"both","billing_class":"facility"}]},{"description":"PHENOL 180ML MW","code_information":[{"code":"3849","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.3,"discounted_cash":4.15,"setting":"both","billing_class":"facility"}]},{"description":"RAVULIZUMB CWVZ 1100","code_information":[{"code":"3854","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":435.57,"discounted_cash":217.78,"setting":"both","billing_class":"facility"}]},{"description":"TIMOLOL XE  0.5% OS","code_information":[{"code":"3855","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":169.55,"discounted_cash":84.78,"setting":"both","billing_class":"facility"}]},{"description":"PHENYLEPH OS 10% 5ML","code_information":[{"code":"3860","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":60.1,"setting":"both","billing_class":"facility"}]},{"description":"PILOCARP OS 1% 15ML","code_information":[{"code":"3865","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":246.65,"discounted_cash":123.33,"setting":"both","billing_class":"facility"}]},{"description":"PILOCARP OS 2% 15ML","code_information":[{"code":"3866","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility"}]},{"description":"PILOCARP OS 4% 15ML","code_information":[{"code":"3867","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":198.45,"discounted_cash":99.22,"setting":"both","billing_class":"facility"}]},{"description":"PHENYLEP NSS 1% 15ML","code_information":[{"code":"3870","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.15,"discounted_cash":6.58,"setting":"both","billing_class":"facility"}]},{"description":"PROMETH 25MG T","code_information":[{"code":"3873","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":1.1,"setting":"both","billing_class":"facility"}]},{"description":"PYRIDOSTIG BR 60MG","code_information":[{"code":"3875","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"SELEN SUL 2.5% 120ML","code_information":[{"code":"3876","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9595","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.7,"discounted_cash":30.35,"setting":"both","billing_class":"facility"}]},{"description":"SILVER NIT STK APP","code_information":[{"code":"3878","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9595","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":1.15,"setting":"both","billing_class":"facility"}]},{"description":"SOD CL OS 5% 15ML","code_information":[{"code":"3880","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9595","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.2,"discounted_cash":19.1,"setting":"both","billing_class":"facility"}]},{"description":"TETRAHYD0.05 OS 15ML","code_information":[{"code":"3886","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9595","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"TIMOLOL OS 0.5% 5ML","code_information":[{"code":"3888","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9595","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.8,"discounted_cash":9.4,"setting":"both","billing_class":"facility"}]},{"description":"PRODERM GRANULX SPRY","code_information":[{"code":"3891","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.85,"discounted_cash":26.93,"setting":"both","billing_class":"facility"}]},{"description":"WITCH HAZ 50% PD 40","code_information":[{"code":"3893","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":3.75,"setting":"both","billing_class":"facility"}]},{"description":"ACETIC ACID ANY % 30","code_information":[{"code":"3899","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.9,"discounted_cash":10.95,"setting":"both","billing_class":"facility"}]},{"description":"ROCKY MTN SPOTIGG/GM","code_information":[{"code":"390","type":"CDM"},{"code":"302","type":"RC"},{"code":"86757","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":92.65,"discounted_cash":46.33,"setting":"both","billing_class":"facility"}]},{"description":"NICOTINE 2MG GUM EA","code_information":[{"code":"3900","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"DIVALPROEX 500 TBEC","code_information":[{"code":"3906","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":3.05,"setting":"both","billing_class":"facility"}]},{"description":"ATORVASTAT 10MG T","code_information":[{"code":"3908","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.55,"discounted_cash":3.77,"setting":"both","billing_class":"facility"}]},{"description":"VALPROATE 250/5 5ML","code_information":[{"code":"3914","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":1.1,"setting":"both","billing_class":"facility"}]},{"description":"SOD POLYS S 15G/60ML","code_information":[{"code":"3916","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility"}]},{"description":"LAMOTRIGINE 25MG T","code_information":[{"code":"3919","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.2,"discounted_cash":4.1,"setting":"both","billing_class":"facility"}]},{"description":"LEVOFLOX 500MG T","code_information":[{"code":"3921","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.65,"discounted_cash":31.82,"setting":"both","billing_class":"facility"}]},{"description":"PENTOSAN  PSS 100MG","code_information":[{"code":"3923","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.15,"discounted_cash":10.07,"setting":"both","billing_class":"facility"}]},{"description":"PHENYLEP 2.5% OS 2ML","code_information":[{"code":"3924","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":135.2,"discounted_cash":67.6,"setting":"both","billing_class":"facility"}]},{"description":"SOD HYAL 12.8MG/0.8M","code_information":[{"code":"3925","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":342.45,"discounted_cash":171.22,"setting":"both","billing_class":"facility"}]},{"description":"TIZANIDINE 4MG T","code_information":[{"code":"3926","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.38,"setting":"both","billing_class":"facility"}]},{"description":"CARVEDILOL 3.125MG T","code_information":[{"code":"3927","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.65,"discounted_cash":1.83,"setting":"both","billing_class":"facility"}]},{"description":"METHADONE 10MG T","code_information":[{"code":"3931","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.73,"setting":"both","billing_class":"facility"}]},{"description":"SERTRALINE 100MG T","code_information":[{"code":"3934","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.4,"discounted_cash":12.2,"setting":"both","billing_class":"facility"}]},{"description":"PREDNISOLONE  5/5 5M","code_information":[{"code":"3937","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.02,"discounted_cash":3.51,"setting":"both","billing_class":"facility"}]},{"description":"ALB/IPRATR 14.7G AER","code_information":[{"code":"3938","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":692.85,"discounted_cash":346.43,"setting":"both","billing_class":"facility"}]},{"description":"BUPROPR 150MG SRT","code_information":[{"code":"3940","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.4,"discounted_cash":8.2,"setting":"both","billing_class":"facility"}]},{"description":"LEVOTHYROX 0.125MG","code_information":[{"code":"3941","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.32,"setting":"both","billing_class":"facility"}]},{"description":"TAMSULOS O.4MG SRC","code_information":[{"code":"3944","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":3.85,"setting":"both","billing_class":"facility"}]},{"description":"VENLAFAXINE 37.5 SRT","code_information":[{"code":"3945","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.65,"discounted_cash":3.83,"setting":"both","billing_class":"facility"}]},{"description":"VALACYCLOV 500MG T","code_information":[{"code":"3947","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.6,"discounted_cash":6.8,"setting":"both","billing_class":"facility"}]},{"description":"AMOX/KCLAV 875MG T","code_information":[{"code":"3948","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":4.88,"setting":"both","billing_class":"facility"}]},{"description":"LOSARTAN 100MG TAB","code_information":[{"code":"3950","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.05,"discounted_cash":3.02,"setting":"both","billing_class":"facility"}]},{"description":"FLUNISOL 250MCG AER","code_information":[{"code":"3952","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":213.05,"discounted_cash":106.53,"setting":"both","billing_class":"facility"}]},{"description":"ZINC SULF 220MG C","code_information":[{"code":"3954","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"IRBESARTAN 150MG T","code_information":[{"code":"3956","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":2.88,"setting":"both","billing_class":"facility"}]},{"description":"TRIFLUOPER 1MG T","code_information":[{"code":"3957","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"INDINAVIR 400MG C","code_information":[{"code":"3961","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility"}]},{"description":"LAMIVUDINE 150MG T","code_information":[{"code":"3962","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.6,"discounted_cash":8.3,"setting":"both","billing_class":"facility"}]},{"description":"ZIDOVUDINE 100MG C","code_information":[{"code":"3963","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":2.08,"setting":"both","billing_class":"facility"}]},{"description":"BUPROPR 100MG SRT","code_information":[{"code":"3964","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.15,"discounted_cash":7.58,"setting":"both","billing_class":"facility"}]},{"description":"OXYCODONE 10MG SRT","code_information":[{"code":"3968","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility"}]},{"description":"BELL/OP  RS 30MG (15","code_information":[{"code":"3973","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":68.9,"discounted_cash":34.45,"setting":"both","billing_class":"facility"}]},{"description":"CARVEDILOL12.5MG T","code_information":[{"code":"3985","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":1.95,"setting":"both","billing_class":"facility"}]},{"description":"BRIMONID 0.2%OS 5ML","code_information":[{"code":"3987","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":163.85,"discounted_cash":81.92,"setting":"both","billing_class":"facility"}]},{"description":"CLOPIDOGREL 75MG T","code_information":[{"code":"3989","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.8,"discounted_cash":6.4,"setting":"both","billing_class":"facility"}]},{"description":"DAPSONE  25MG T","code_information":[{"code":"3991","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":2.55,"setting":"both","billing_class":"facility"}]},{"description":"QUETIAPINE 100MG T","code_information":[{"code":"3992","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.13,"setting":"both","billing_class":"facility"}]},{"description":"BARIUM SULF OS 176GM","code_information":[{"code":"3995","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":13.75,"setting":"both","billing_class":"facility"}]},{"description":"TOLCAPONE 100MG T","code_information":[{"code":"3996","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":91.1,"discounted_cash":45.55,"setting":"both","billing_class":"facility"}]},{"description":"METFORMIN 850MG T","code_information":[{"code":"3998","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":1.15,"setting":"both","billing_class":"facility"}]},{"description":"OP BLADDER SCAN","code_information":[{"code":"40","type":"CDM"},{"code":"361","type":"RC"},{"code":"51798","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":287.95,"discounted_cash":143.97,"setting":"both","billing_class":"facility"}]},{"description":"REPAGLINIDE 0.5MG T","code_information":[{"code":"4000","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"TOLTERODINE 2MG T","code_information":[{"code":"4007","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.17,"setting":"both","billing_class":"facility"}]},{"description":"IBUPR HCD 200/7.5 T","code_information":[{"code":"4008","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"CITALOPRAM 20MG T","code_information":[{"code":"4009","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":2.52,"setting":"both","billing_class":"facility"}]},{"description":"HC/APAP 10/500 T","code_information":[{"code":"4011","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"GLUCOSE 40% 15G GEL","code_information":[{"code":"4016","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":6.25,"setting":"both","billing_class":"facility"}]},{"description":"DISOPYRAM 100MG SRC","code_information":[{"code":"4017","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":2.85,"setting":"both","billing_class":"facility"}]},{"description":"NEO/POLY/DEX OO 3.5","code_information":[{"code":"4020","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.15,"discounted_cash":55.08,"setting":"both","billing_class":"facility"}]},{"description":"BISOPR/HCTZ 2.5/6.25","code_information":[{"code":"4023","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.05,"setting":"both","billing_class":"facility"}]},{"description":"QUININE SULF 324 T","code_information":[{"code":"4024","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.4,"discounted_cash":7.7,"setting":"both","billing_class":"facility"}]},{"description":"DORZOL/TIMOL 2/0.5 O","code_information":[{"code":"4026","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":448.2,"discounted_cash":224.1,"setting":"both","billing_class":"facility"}]},{"description":"CELECOXIB 100MG C","code_information":[{"code":"4036","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.95,"discounted_cash":8.47,"setting":"both","billing_class":"facility"}]},{"description":"TRANDOLAPR 4MG T\\\\","code_information":[{"code":"4042","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":1.15,"setting":"both","billing_class":"facility"}]},{"description":"BAC/POLYB OINT 0.9GM","code_information":[{"code":"4043","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.63,"setting":"both","billing_class":"facility"}]},{"description":"MISOPROS 100 MCG T","code_information":[{"code":"4044","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.95,"discounted_cash":4.47,"setting":"both","billing_class":"facility"}]},{"description":"SCOPOLAMINE 1 MG/72","code_information":[{"code":"4046","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.85,"discounted_cash":31.93,"setting":"both","billing_class":"facility"}]},{"description":"QUINAPRIL HCL 5MG T","code_information":[{"code":"4048","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":1.15,"setting":"both","billing_class":"facility"}]},{"description":"RALOXIFENE HCI 60 T","code_information":[{"code":"4049","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.45,"discounted_cash":6.72,"setting":"both","billing_class":"facility"}]},{"description":"OLOPATAD 0.1% OS 5ML","code_information":[{"code":"4051","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":620.45,"discounted_cash":310.23,"setting":"both","billing_class":"facility"}]},{"description":"CANDESAR 16MG T","code_information":[{"code":"4052","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":3.63,"setting":"both","billing_class":"facility"}]},{"description":"FEXOFENAD 60MG T","code_information":[{"code":"4056","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":1.1,"setting":"both","billing_class":"facility"}]},{"description":"VOSOL HC DRPS 10ML","code_information":[{"code":"4058","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":378.1,"discounted_cash":189.05,"setting":"both","billing_class":"facility"}]},{"description":"ROSIGLIT MAL 4MG T","code_information":[{"code":"4061","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":5.1,"setting":"both","billing_class":"facility"}]},{"description":"BUDESON 180MCG AER","code_information":[{"code":"4065","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.45,"discounted_cash":221.72,"setting":"both","billing_class":"facility"}]},{"description":"MILES MIXTURE 120ML","code_information":[{"code":"4067","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.15,"discounted_cash":18.07,"setting":"both","billing_class":"facility"}]},{"description":"TELMISART 80MG T","code_information":[{"code":"4075","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.1,"discounted_cash":7.05,"setting":"both","billing_class":"facility"}]},{"description":"OXYCODONE 40MG SRT","code_information":[{"code":"4076","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":13.32,"setting":"both","billing_class":"facility"}]},{"description":"CIPROFL  OO 0.3%3.5G","code_information":[{"code":"4078","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.25,"discounted_cash":241.63,"setting":"both","billing_class":"facility"}]},{"description":"AMOXICILLIN 875MG T","code_information":[{"code":"4081","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"DAKINS 1/2 STR 480ML","code_information":[{"code":"4083","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility"}]},{"description":"RISPERIDO 0.25 MG T","code_information":[{"code":"4087","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.3,"discounted_cash":3.65,"setting":"both","billing_class":"facility"}]},{"description":"MELOXICAM 7.5MG T","code_information":[{"code":"4088","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":3.08,"setting":"both","billing_class":"facility"}]},{"description":"PIOGLITAZONE 15MG T","code_information":[{"code":"4090","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":5.33,"setting":"both","billing_class":"facility"}]},{"description":"LEVALBUT 0.63/3ML AE","code_information":[{"code":"4092","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.35,"discounted_cash":6.17,"setting":"both","billing_class":"facility"}]},{"description":"LEVALBUT 1.25/3ML AE","code_information":[{"code":"4093","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.55,"discounted_cash":6.28,"setting":"both","billing_class":"facility"}]},{"description":"AMILORIDE  5MG T","code_information":[{"code":"4095","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.18,"setting":"both","billing_class":"facility"}]},{"description":"OP BLADDER IRIG/LAVG","code_information":[{"code":"41","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.79,"discounted_cash":234.4,"setting":"both","billing_class":"facility"}]},{"description":"OXYBUTYNIN 5MG SRT","code_information":[{"code":"4102","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.3,"discounted_cash":7.15,"setting":"both","billing_class":"facility"}]},{"description":"CILOSTAZOL 100MG T","code_information":[{"code":"4104","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":1.8,"setting":"both","billing_class":"facility"}]},{"description":"COLESTIPOL 1GM T","code_information":[{"code":"4105","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":2.42,"setting":"both","billing_class":"facility"}]},{"description":"NEPHRO VITE TAB","code_information":[{"code":"4106","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"DIPYR/ASA 25/200 SRC","code_information":[{"code":"4108","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.45,"discounted_cash":9.72,"setting":"both","billing_class":"facility"}]},{"description":"VENLAFAX 75MG SRT","code_information":[{"code":"4111","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.45,"discounted_cash":16.23,"setting":"both","billing_class":"facility"}]},{"description":"CARVEDILOL 6.25MG T","code_information":[{"code":"4113","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":1.93,"setting":"both","billing_class":"facility"}]},{"description":"TRIFLURIDIN OS 7.5ML","code_information":[{"code":"4116","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":387.65,"discounted_cash":193.82,"setting":"both","billing_class":"facility"}]},{"description":"MICON  2% AERPWD","code_information":[{"code":"4118","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":3.88,"setting":"both","billing_class":"facility"}]},{"description":"FOLTX TAB 1EA","code_information":[{"code":"4120","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":1.4,"setting":"both","billing_class":"facility"}]},{"description":"ACYCLOVIR 200/5 5ML","code_information":[{"code":"4129","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":7.53,"setting":"both","billing_class":"facility"}]},{"description":"LEFLUNOMIDE 10MG T","code_information":[{"code":"4131","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":5.63,"setting":"both","billing_class":"facility"}]},{"description":"MYCOFEN MOF 250 T","code_information":[{"code":"4134","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.69,"discounted_cash":3.85,"setting":"both","billing_class":"facility"}]},{"description":"TOLTEROD 2MG SRT","code_information":[{"code":"4137","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.45,"discounted_cash":13.72,"setting":"both","billing_class":"facility"}]},{"description":"MODAFINIL 100MG T","code_information":[{"code":"4138","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.65,"discounted_cash":25.32,"setting":"both","billing_class":"facility"}]},{"description":"ZANAMIVIR 5MG AER","code_information":[{"code":"4141","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":153.6,"discounted_cash":76.8,"setting":"both","billing_class":"facility"}]},{"description":"ANASTROZOLE 1MG T","code_information":[{"code":"4146","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.1,"discounted_cash":12.55,"setting":"both","billing_class":"facility"}]},{"description":"CEFDINIR 300MG C","code_information":[{"code":"4147","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.6,"discounted_cash":4.8,"setting":"both","billing_class":"facility"}]},{"description":"FISH OIL 1000MG CAP","code_information":[{"code":"4149","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"RIVASTIGMINE 1.5MG C","code_information":[{"code":"4157","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":4.35,"setting":"both","billing_class":"facility"}]},{"description":"ENTACAPONE 200MG TAB","code_information":[{"code":"4158","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.35,"discounted_cash":8.68,"setting":"both","billing_class":"facility"}]},{"description":"LINEZOLID 600MG T","code_information":[{"code":"4162","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":361.85,"discounted_cash":180.93,"setting":"both","billing_class":"facility"}]},{"description":"BUDESON .5MG/2 RSP","code_information":[{"code":"4166","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.8,"discounted_cash":11.4,"setting":"both","billing_class":"facility"}]},{"description":"LEVOTHYROX 0.075MG T","code_information":[{"code":"4167","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.32,"setting":"both","billing_class":"facility"}]},{"description":"TOPIRAMATE 25MG T","code_information":[{"code":"4170","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":2.25,"setting":"both","billing_class":"facility"}]},{"description":"GALANTAMINE 4MG T","code_information":[{"code":"4172","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility"}]},{"description":"OFLOX 0.3% OTIC 5ML","code_information":[{"code":"4175","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":194.5,"discounted_cash":97.25,"setting":"both","billing_class":"facility"}]},{"description":"ESTRADIOL TDP 0.025","code_information":[{"code":"4180","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.25,"discounted_cash":43.13,"setting":"both","billing_class":"facility"}]},{"description":"FLUOCIN .05% OI 30GM","code_information":[{"code":"4184","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.4,"discounted_cash":55.2,"setting":"both","billing_class":"facility"}]},{"description":"ZIPRASIDONE 20MG C","code_information":[{"code":"4187","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.8,"discounted_cash":8.4,"setting":"both","billing_class":"facility"}]},{"description":"CARBAMAZ 100MG SRT","code_information":[{"code":"4191","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.5,"setting":"both","billing_class":"facility"}]},{"description":"PROPAFENONE 150MG T","code_information":[{"code":"4193","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.8,"setting":"both","billing_class":"facility"}]},{"description":"LOSARTAN  K 50MG T","code_information":[{"code":"4194","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.05,"discounted_cash":2.02,"setting":"both","billing_class":"facility"}]},{"description":"LOSARTAN K 25MG T","code_information":[{"code":"4195","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.35,"discounted_cash":1.68,"setting":"both","billing_class":"facility"}]},{"description":"FLUVASTATIN 20MG C","code_information":[{"code":"4197","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":6.2,"setting":"both","billing_class":"facility"}]},{"description":"M/S OP PROCEDURE","code_information":[{"code":"42","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":578.67,"discounted_cash":289.33,"setting":"both","billing_class":"facility"}]},{"description":"TERCONAZ VCR 45G","code_information":[{"code":"4200","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.6,"discounted_cash":53.8,"setting":"both","billing_class":"facility"}]},{"description":"TOBRA,DEX OO 3.5G","code_information":[{"code":"4201","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":514.5,"discounted_cash":257.25,"setting":"both","billing_class":"facility"}]},{"description":"FLUCONAZ 100MG T","code_information":[{"code":"4202","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.3,"discounted_cash":8.15,"setting":"both","billing_class":"facility"}]},{"description":"LOTREL 5/10 C","code_information":[{"code":"4205","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":2.85,"setting":"both","billing_class":"facility"}]},{"description":"TRAMADOL 50MG T","code_information":[{"code":"4206","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.53,"setting":"both","billing_class":"facility"}]},{"description":"METFORMIN 500MG T","code_information":[{"code":"4207","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"DONEPEZIL 5MG T","code_information":[{"code":"4210","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility"}]},{"description":"MESALAMINE 250 SRC","code_information":[{"code":"4213","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.8,"discounted_cash":3.4,"setting":"both","billing_class":"facility"}]},{"description":"AZITHRO 100/5 15ML","code_information":[{"code":"4216","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":3.75,"setting":"both","billing_class":"facility"}]},{"description":"MIRTAZAPINE 15MG T","code_information":[{"code":"4222","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.65,"discounted_cash":6.33,"setting":"both","billing_class":"facility"}]},{"description":"GLIMEPIRIDE 4MG T","code_information":[{"code":"4224","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"CETIRIZINE 10MG T","code_information":[{"code":"4226","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":2.42,"setting":"both","billing_class":"facility"}]},{"description":"IPRATROP BR NS 0.03","code_information":[{"code":"4228","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.3,"discounted_cash":105.15,"setting":"both","billing_class":"facility"}]},{"description":"SUMATRIPTAN 25MG T","code_information":[{"code":"4229","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.75,"discounted_cash":25.38,"setting":"both","billing_class":"facility"}]},{"description":"ACARBOSE 50MG T","code_information":[{"code":"4230","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"OLANZAPINE 5 MG T","code_information":[{"code":"4232","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.45,"discounted_cash":15.22,"setting":"both","billing_class":"facility"}]},{"description":"BICALUTAMIDE 50MG T","code_information":[{"code":"4234","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.05,"discounted_cash":17.52,"setting":"both","billing_class":"facility"}]},{"description":"LORATADINE/PSE 12H T","code_information":[{"code":"4240","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"ZAFIRLUKAST  20MG T","code_information":[{"code":"4241","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.1,"discounted_cash":2.05,"setting":"both","billing_class":"facility"}]},{"description":"CEFPROZIL 250/5 50ML","code_information":[{"code":"4243","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":3.42,"setting":"both","billing_class":"facility"}]},{"description":"POT BIC/CA  25MEQ ET","code_information":[{"code":"4244","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"BISOPROLOL 5MG T","code_information":[{"code":"4249","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.18,"setting":"both","billing_class":"facility"}]},{"description":"LATANOPROST OS 2.5ML","code_information":[{"code":"4251","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.1,"discounted_cash":30.55,"setting":"both","billing_class":"facility"}]},{"description":"MONTELUKAST 10MG T","code_information":[{"code":"4261","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":5.1,"setting":"both","billing_class":"facility"}]},{"description":"PHOSPHOSOD 45ML SOLN","code_information":[{"code":"4262","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.85,"discounted_cash":5.42,"setting":"both","billing_class":"facility"}]},{"description":"METOPROLOL 25MG TAB","code_information":[{"code":"4268","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"FLUT/SALM 45-21 AE","code_information":[{"code":"4275","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":478.8,"discounted_cash":239.4,"setting":"both","billing_class":"facility"}]},{"description":"ANALGESIC BALM 15-15","code_information":[{"code":"4279","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"CARBAMIDE PEROX 6.5%","code_information":[{"code":"4281","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":8.13,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCORT 10 MG TAB","code_information":[{"code":"4285","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":1.02,"setting":"both","billing_class":"facility"}]},{"description":"PANCRELIPASE CAPS","code_information":[{"code":"4286","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.4,"discounted_cash":1.7,"setting":"both","billing_class":"facility"}]},{"description":"GLIPIZIDE 10MG TABS","code_information":[{"code":"4292","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.18,"setting":"both","billing_class":"facility"}]},{"description":"GLIPIZIDE XL 10MG TA","code_information":[{"code":"4293","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCO APAP 5 500MG","code_information":[{"code":"4297","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"EEG 41-60 MINUTES","code_information":[{"code":"43","type":"CDM"},{"code":"740","type":"RC"},{"code":"95812","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":922.11,"discounted_cash":461.06,"setting":"both","billing_class":"facility"}]},{"description":"LEVETIRACET 500MG TA","code_information":[{"code":"4300","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":3.25,"setting":"both","billing_class":"facility"}]},{"description":"LEVOTHYROX NA 0.025","code_information":[{"code":"4302","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.73,"setting":"both","billing_class":"facility"}]},{"description":"METOCLOP HCL 5MG TAB","code_information":[{"code":"4303","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"PREDNISONE 1MG TAB","code_information":[{"code":"4308","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.52,"setting":"both","billing_class":"facility"}]},{"description":"LISINOPRIL 2.5MG T","code_information":[{"code":"4309","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"PANTOPRAZOLE 40MG T","code_information":[{"code":"4311","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.55,"discounted_cash":3.77,"setting":"both","billing_class":"facility"}]},{"description":"METOPROL XL 50MG TAB","code_information":[{"code":"4316","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"SIMVASTATIN 20MG TAB","code_information":[{"code":"4319","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.95,"discounted_cash":4.47,"setting":"both","billing_class":"facility"}]},{"description":"NITRO TAB 0.4MG","code_information":[{"code":"4322","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.05,"setting":"both","billing_class":"facility"}]},{"description":"ZINC OXIDE 40%","code_information":[{"code":"4328","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":5.45,"setting":"both","billing_class":"facility"}]},{"description":"ENOXAPARIN 60MG/ML","code_information":[{"code":"4335","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.47,"discounted_cash":12.73,"setting":"both","billing_class":"facility"}]},{"description":"ROPINIROLE 0.5 MG TA","code_information":[{"code":"4338","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.55,"discounted_cash":3.77,"setting":"both","billing_class":"facility"}]},{"description":"LACRILUBE OINT 3.5GM","code_information":[{"code":"4341","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.2,"discounted_cash":7.1,"setting":"both","billing_class":"facility"}]},{"description":"CA CARB 600MG T","code_information":[{"code":"4346","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"METFORMIN 500MG XR","code_information":[{"code":"4348","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"MIRTAZAPINE 30MG T","code_information":[{"code":"4357","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":5.1,"setting":"both","billing_class":"facility"}]},{"description":"FLUT/SALM 115-21 AE","code_information":[{"code":"4363","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":478.8,"discounted_cash":239.4,"setting":"both","billing_class":"facility"}]},{"description":"CIPRO HC OTIC","code_information":[{"code":"4366","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":348.0,"setting":"both","billing_class":"facility"}]},{"description":"SIMVASTATIN 40MG TAB","code_information":[{"code":"4368","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.05,"discounted_cash":4.53,"setting":"both","billing_class":"facility"}]},{"description":"COLESEVEL HCL 625MG","code_information":[{"code":"4369","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.2,"discounted_cash":4.1,"setting":"both","billing_class":"facility"}]},{"description":"THEOPH TRC 100MG","code_information":[{"code":"4373","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":2.27,"setting":"both","billing_class":"facility"}]},{"description":"CEPHALEX 250/5 100ML","code_information":[{"code":"4375","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"AMLODIPINE 2.5MG T","code_information":[{"code":"4377","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":1.73,"setting":"both","billing_class":"facility"}]},{"description":"CEFDINIR SUSP 125MG","code_information":[{"code":"4385","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"MOXIFLOX 400MG TAB","code_information":[{"code":"4386","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.5,"discounted_cash":32.75,"setting":"both","billing_class":"facility"}]},{"description":"METOPROL XL 25MG T","code_information":[{"code":"4389","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":1.07,"setting":"both","billing_class":"facility"}]},{"description":"ROPINIROLE 2MG  T","code_information":[{"code":"4390","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.55,"discounted_cash":6.28,"setting":"both","billing_class":"facility"}]},{"description":"REPAGLINID 2MG TAB","code_information":[{"code":"4396","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.8,"discounted_cash":3.4,"setting":"both","billing_class":"facility"}]},{"description":"EEG EXTD MNTR 61-119","code_information":[{"code":"44","type":"CDM"},{"code":"740","type":"RC"},{"code":"95813","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":968.3,"discounted_cash":484.15,"setting":"both","billing_class":"facility"}]},{"description":"QUINAPRIL HCL 20MG T","code_information":[{"code":"4400","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"ACETYLCYS 20% 4ML","code_information":[{"code":"4407","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.95,"discounted_cash":23.48,"setting":"both","billing_class":"facility"}]},{"description":"ALBUTEROL 0.5% NEB","code_information":[{"code":"4408","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"NAPROXEN 220MG T","code_information":[{"code":"4410","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.38,"setting":"both","billing_class":"facility"}]},{"description":"FEXOFEN 180 MG TAB","code_information":[{"code":"4411","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":1.4,"setting":"both","billing_class":"facility"}]},{"description":"ARTIFICIAL TEARS","code_information":[{"code":"4431","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":6.88,"setting":"both","billing_class":"facility"}]},{"description":"ASPIRIN EC 81MG T","code_information":[{"code":"4435","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.53,"setting":"both","billing_class":"facility"}]},{"description":"ASPIRIN 300 SUPP","code_information":[{"code":"4436","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"ATORVAST 20MG T","code_information":[{"code":"4438","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":5.5,"setting":"both","billing_class":"facility"}]},{"description":"AURALGAN 5.4-1.4%","code_information":[{"code":"4445","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.45,"discounted_cash":18.73,"setting":"both","billing_class":"facility"}]},{"description":"AZELATINE NS 137MCG","code_information":[{"code":"4446","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":197.75,"discounted_cash":98.88,"setting":"both","billing_class":"facility"}]},{"description":"MUPIROCIN OINT 22G","code_information":[{"code":"4451","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility"}]},{"description":"BENZTROPINE MES 1MG","code_information":[{"code":"4454","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"BICILLIN CR 1.2MU","code_information":[{"code":"4459","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.14,"discounted_cash":12.07,"setting":"both","billing_class":"facility"}]},{"description":"BICITRA 500MG/5ML","code_information":[{"code":"4461","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":4.6,"setting":"both","billing_class":"facility"}]},{"description":"BUTORPHANOL 10MG NS","code_information":[{"code":"4467","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":120.5,"setting":"both","billing_class":"facility"}]},{"description":"CEFPROZIL TAB 250MG","code_information":[{"code":"4473","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":4.83,"setting":"both","billing_class":"facility"}]},{"description":"PROPERDIN FACTOR B","code_information":[{"code":"448","type":"CDM"},{"code":"300","type":"RC"},{"code":"83883","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"BENZOCAINE 20% SPRAY","code_information":[{"code":"4485","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.65,"discounted_cash":14.82,"setting":"both","billing_class":"facility"}]},{"description":"CHLORHEX GLUC .012 %","code_information":[{"code":"4491","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.3,"discounted_cash":0.15,"setting":"both","billing_class":"facility"}]},{"description":"CHLORPHEN 4MG T","code_information":[{"code":"4492","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"CHOLESTYRAM 4MG POW","code_information":[{"code":"4494","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":3.15,"setting":"both","billing_class":"facility"}]},{"description":"CLORPACTIN 2GM PACK","code_information":[{"code":"4499","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.15,"discounted_cash":9.07,"setting":"both","billing_class":"facility"}]},{"description":"EEG W/O VID 2-12HR","code_information":[{"code":"45","type":"CDM"},{"code":"740","type":"RC"},{"code":"95707","type":"CPT"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":968.3,"discounted_cash":484.15,"setting":"both","billing_class":"facility"}]},{"description":"NEO,BAC,PMX,HC 15G O","code_information":[{"code":"4506","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":251.2,"discounted_cash":125.6,"setting":"both","billing_class":"facility"}]},{"description":"DEMECLOCY 150MG T","code_information":[{"code":"4512","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility"}]},{"description":"CAL/VIT D 500MG T","code_information":[{"code":"4518","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.48,"setting":"both","billing_class":"facility"}]},{"description":"ENALAPRIL 2.5MG T","code_information":[{"code":"4535","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.32,"setting":"both","billing_class":"facility"}]},{"description":"ETODOLAC 400MG T","code_information":[{"code":"4541","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL TD 100MCG/H","code_information":[{"code":"4544","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":133.9,"discounted_cash":66.95,"setting":"both","billing_class":"facility"}]},{"description":"FERR GLUC 325MG T","code_information":[{"code":"4548","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"FER SULF 324MG T","code_information":[{"code":"4549","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"CALC POLY 625MG T","code_information":[{"code":"4551","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"APAP/CAFF/BUT T","code_information":[{"code":"4552","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":1.75,"setting":"both","billing_class":"facility"}]},{"description":"FUROSEMIDE 80MG T LA","code_information":[{"code":"4558","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":1.4,"setting":"both","billing_class":"facility"}]},{"description":"GENTAM .1% OINT","code_information":[{"code":"4561","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":247.65,"discounted_cash":123.83,"setting":"both","billing_class":"facility"}]},{"description":"GENTAM .3% OP SOL","code_information":[{"code":"4563","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.95,"discounted_cash":27.48,"setting":"both","billing_class":"facility"}]},{"description":"COLLAGENASE 30GM OIN","code_information":[{"code":"4567","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":521.05,"discounted_cash":260.52,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCORT .5% 30GM","code_information":[{"code":"4580","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.95,"discounted_cash":4.97,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCORT 1% OI","code_information":[{"code":"4581","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.05,"discounted_cash":10.03,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCHLORO 25MG T","code_information":[{"code":"4584","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"HYDROXY 10MG T","code_information":[{"code":"4586","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.48,"setting":"both","billing_class":"facility"}]},{"description":"HYDROX 2MG SYR","code_information":[{"code":"4587","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"ISOSORBIDE 60MG T","code_information":[{"code":"4592","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"2NORTH PRIVATE","code_information":[{"code":"46","type":"CDM"},{"code":"111","type":"RC"},{"code":"95707","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":1093.75,"discounted_cash":546.88,"setting":"both","billing_class":"facility"}]},{"description":"LISINOPRIL 20MG T","code_information":[{"code":"4601","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":1.07,"setting":"both","billing_class":"facility"}]},{"description":"LORAZEPAM .5MG T","code_information":[{"code":"4606","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"HYDRO-APAP 7.5-500MG","code_information":[{"code":"4608","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"METRONID 500MG T","code_information":[{"code":"4622","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":1.15,"setting":"both","billing_class":"facility"}]},{"description":"MYLANTA  1 OZ","code_information":[{"code":"4635","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":2.52,"setting":"both","billing_class":"facility"}]},{"description":"NADOLOL 20MG T","code_information":[{"code":"4637","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.17,"setting":"both","billing_class":"facility"}]},{"description":"NTG 0.1MG HR PTC","code_information":[{"code":"4649","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.1,"discounted_cash":4.05,"setting":"both","billing_class":"facility"}]},{"description":"BROMOCRIPT 2.5MG C","code_information":[{"code":"4658","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":3.88,"setting":"both","billing_class":"facility"}]},{"description":"PERPHEN 2MG T","code_information":[{"code":"4666","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":1.63,"setting":"both","billing_class":"facility"}]},{"description":"POLYS/IRON 150MG C","code_information":[{"code":"4670","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.53,"setting":"both","billing_class":"facility"}]},{"description":"POLYTRIM OP SOL","code_information":[{"code":"4671","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.15,"discounted_cash":21.07,"setting":"both","billing_class":"facility"}]},{"description":"POTASSIUM CL 8MEQ T","code_information":[{"code":"4673","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"MD SCREEN QUAL EA","code_information":[{"code":"468","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.8,"discounted_cash":39.4,"setting":"both","billing_class":"facility"}]},{"description":"QUETIAPINE 25MG T","code_information":[{"code":"4695","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":3.75,"setting":"both","billing_class":"facility"}]},{"description":"BACT SOD CL 30ML","code_information":[{"code":"4699","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"2NORTH SEMI PVT","code_information":[{"code":"47","type":"CDM"},{"code":"121","type":"RC"},{"code":"95707","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":1093.75,"discounted_cash":546.88,"setting":"both","billing_class":"facility"}]},{"description":"CARBIDOPA/LEV 10/100","code_information":[{"code":"4704","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.05,"setting":"both","billing_class":"facility"}]},{"description":"SOD CL 1GM T","code_information":[{"code":"4710","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"PAP CARDIOLIP AB","code_information":[{"code":"472","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.65,"discounted_cash":33.33,"setting":"both","billing_class":"facility"}]},{"description":"PAP PHOSPHOLIPID AB","code_information":[{"code":"473","type":"CDM"},{"code":"300","type":"RC"},{"code":"86148","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.65,"discounted_cash":33.33,"setting":"both","billing_class":"facility"}]},{"description":"TRAZODONE 100MG T","code_information":[{"code":"4732","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"PAP GLYCOPROTEIN AB","code_information":[{"code":"474","type":"CDM"},{"code":"300","type":"RC"},{"code":"86146","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.65,"discounted_cash":33.33,"setting":"both","billing_class":"facility"}]},{"description":"VCP LIPOPROTEIN HR","code_information":[{"code":"475","type":"CDM"},{"code":"300","type":"RC"},{"code":"83701","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":104.2,"discounted_cash":52.1,"setting":"both","billing_class":"facility"}]},{"description":"VCP TRIGLYCERIDES","code_information":[{"code":"476","type":"CDM"},{"code":"300","type":"RC"},{"code":"84478","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility"}]},{"description":"CALCIUM CITRATE TAB","code_information":[{"code":"4761","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.43,"setting":"both","billing_class":"facility"}]},{"description":"DEXAMETH 0.5/5ML EL","code_information":[{"code":"4763","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":1.55,"setting":"both","billing_class":"facility"}]},{"description":"BIMATOPROST .03% OS","code_information":[{"code":"4767","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.85,"discounted_cash":221.93,"setting":"both","billing_class":"facility"}]},{"description":"CALMOSEPT OINT 4OZ","code_information":[{"code":"4771","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":6.88,"setting":"both","billing_class":"facility"}]},{"description":"ATORVAST 40MG T","code_information":[{"code":"4778","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":5.45,"setting":"both","billing_class":"facility"}]},{"description":"GI COCKTAIL","code_information":[{"code":"4783","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.8,"discounted_cash":9.4,"setting":"both","billing_class":"facility"}]},{"description":"CAL CARB VIT D 600MG","code_information":[{"code":"4787","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.48,"setting":"both","billing_class":"facility"}]},{"description":"THROMBIN 20000U SPR","code_information":[{"code":"4789","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":669.8,"discounted_cash":334.9,"setting":"both","billing_class":"facility"}]},{"description":"CYCLOPHOS 50MG T","code_information":[{"code":"4790","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":6.13,"setting":"both","billing_class":"facility"}]},{"description":"2NORTH ISOLATION","code_information":[{"code":"48","type":"CDM"},{"code":"164","type":"RC"},{"code":"95707","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":1137.35,"discounted_cash":568.67,"setting":"both","billing_class":"facility"}]},{"description":"RONDEC DM LIG 30ML","code_information":[{"code":"4803","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"DOXAZOSIN 4MG TAB","code_information":[{"code":"4804","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"TRAM/ACE 37.5/325MGT","code_information":[{"code":"4808","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"CYCLOSPOR 25MG CAP","code_information":[{"code":"4815","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"TOPIRAMATE 100MG T","code_information":[{"code":"4819","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":6.2,"setting":"both","billing_class":"facility"}]},{"description":"MONTELUK 4MG CHEWTAB","code_information":[{"code":"4825","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.6,"discounted_cash":4.8,"setting":"both","billing_class":"facility"}]},{"description":"NABUMETONE 750MG T","code_information":[{"code":"4829","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"LIDO 2% JELLY 30ML","code_information":[{"code":"4834","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.35,"discounted_cash":27.18,"setting":"both","billing_class":"facility"}]},{"description":"SEVEL HCL 800MG T","code_information":[{"code":"4836","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":7.97,"setting":"both","billing_class":"facility"}]},{"description":"DICLOXACILN 250MG C","code_information":[{"code":"4839","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"ENSURE CLR 240ML LIQ","code_information":[{"code":"4840","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility"}]},{"description":"RID SHAMPOO","code_information":[{"code":"4843","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":5.3,"setting":"both","billing_class":"facility"}]},{"description":"CETIRIZINE 1MG/ML","code_information":[{"code":"4848","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"LANOLIN OINT .25OZ","code_information":[{"code":"4850","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"RIZATRIPTAN 10MG T","code_information":[{"code":"4853","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.75,"discounted_cash":32.88,"setting":"both","billing_class":"facility"}]},{"description":"CARBAMAZ 200MG SRT T","code_information":[{"code":"4855","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"PROMETH VC W/COD 5ML","code_information":[{"code":"4858","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":3.95,"setting":"both","billing_class":"facility"}]},{"description":"AMINOPHY 100MG T","code_information":[{"code":"4859","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"CHLORASEPTIC LOZ","code_information":[{"code":"4862","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"PEDIAZ 200/600MG/5ML","code_information":[{"code":"4872","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.27,"setting":"both","billing_class":"facility"}]},{"description":"ESTR/METH 1.25-2.5 T","code_information":[{"code":"4875","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":2.08,"setting":"both","billing_class":"facility"}]},{"description":"HYCODAN SYRUP 5ML","code_information":[{"code":"4882","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility"}]},{"description":"METHOTREX 2.5MG T","code_information":[{"code":"4889","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.7,"discounted_cash":3.35,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPHEN 10MG T","code_information":[{"code":"4891","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.98,"setting":"both","billing_class":"facility"}]},{"description":"NIACIN 500MG SRC","code_information":[{"code":"4895","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.9,"discounted_cash":4.95,"setting":"both","billing_class":"facility"}]},{"description":"2N OBS 1 HR","code_information":[{"code":"49","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":593.9,"discounted_cash":296.95,"setting":"both","billing_class":"facility"}]},{"description":"BENAZEPRIL 40MG T","code_information":[{"code":"4912","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.18,"setting":"both","billing_class":"facility"}]},{"description":"HC/APAP 10/325 T","code_information":[{"code":"4928","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"OSEL/PHOS 75MG C","code_information":[{"code":"4939","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":17.13,"setting":"both","billing_class":"facility"}]},{"description":"MIRALAX 17GM PWD EA","code_information":[{"code":"4940","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":1.48,"setting":"both","billing_class":"facility"}]},{"description":"WARFARIN 3MG TAB","code_information":[{"code":"4948","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":2.5,"setting":"both","billing_class":"facility"}]},{"description":"FLUTIC/SALMET 100MCG","code_information":[{"code":"4954","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.1,"discounted_cash":18.05,"setting":"both","billing_class":"facility"}]},{"description":"FLUTIC/SALMET 250MCG","code_information":[{"code":"4955","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.1,"discounted_cash":18.05,"setting":"both","billing_class":"facility"}]},{"description":"FLU/SALM 230/21 AE","code_information":[{"code":"4956","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":710.05,"discounted_cash":355.02,"setting":"both","billing_class":"facility"}]},{"description":"LOPERAMIDE 1MG/5 OR","code_information":[{"code":"4961","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"TRAVAPROST OS 2.5ML","code_information":[{"code":"4968","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":396.35,"discounted_cash":198.18,"setting":"both","billing_class":"facility"}]},{"description":"ETH EST/NORGES 30/.3","code_information":[{"code":"4971","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.45,"discounted_cash":31.73,"setting":"both","billing_class":"facility"}]},{"description":"GLYB/METF 2.5/500 T","code_information":[{"code":"4974","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"GLYB/METF 5/500 T","code_information":[{"code":"4975","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"AMMOLAC LTN 12% 8 OZ","code_information":[{"code":"4981","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.15,"discounted_cash":47.58,"setting":"both","billing_class":"facility"}]},{"description":"FENOFIBRATE 160MG T","code_information":[{"code":"4982","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":6.75,"setting":"both","billing_class":"facility"}]},{"description":"DESLORATIDINE 5MG T","code_information":[{"code":"4988","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":6.47,"setting":"both","billing_class":"facility"}]},{"description":"AMLODIPINE 10MG T","code_information":[{"code":"4989","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.45,"discounted_cash":2.23,"setting":"both","billing_class":"facility"}]},{"description":"GUAIFEN DM 10ML","code_information":[{"code":"4996","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.85,"discounted_cash":3.92,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCO/ACE ELIX 15M","code_information":[{"code":"4998","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.85,"discounted_cash":4.42,"setting":"both","billing_class":"facility"}]},{"description":"ALBUTEROL 6.8GM AER","code_information":[{"code":"4999","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.4,"discounted_cash":55.2,"setting":"both","billing_class":"facility"}]},{"description":"2N OBS ADD HR","code_information":[{"code":"50","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.55,"discounted_cash":27.27,"setting":"both","billing_class":"facility"}]},{"description":"OXYCODONE 5MG TAB","code_information":[{"code":"5004","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":1.02,"setting":"both","billing_class":"facility"}]},{"description":"MUPIRO NAS 2% OT 1GM","code_information":[{"code":"5006","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":51.35,"discounted_cash":25.68,"setting":"both","billing_class":"facility"}]},{"description":"LIDODERM 5% PTCH","code_information":[{"code":"5007","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.15,"discounted_cash":28.57,"setting":"both","billing_class":"facility"}]},{"description":"FLUCONAZ 150MG TAB","code_information":[{"code":"5008","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.3,"discounted_cash":13.15,"setting":"both","billing_class":"facility"}]},{"description":"NATEGLINIDE 60MG T","code_information":[{"code":"5009","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.65,"discounted_cash":1.83,"setting":"both","billing_class":"facility"}]},{"description":"FLUTIC/PRO 50MCG INH","code_information":[{"code":"5010","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.35,"discounted_cash":16.18,"setting":"both","billing_class":"facility"}]},{"description":"TROPICAMIDE OS 1% 2M","code_information":[{"code":"5026","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.3,"discounted_cash":24.15,"setting":"both","billing_class":"facility"}]},{"description":"SEVEL CARB 800MG T","code_information":[{"code":"5028","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.65,"discounted_cash":6.33,"setting":"both","billing_class":"facility"}]},{"description":"FLUVASTAT XL 80MG T","code_information":[{"code":"5030","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.45,"discounted_cash":8.72,"setting":"both","billing_class":"facility"}]},{"description":"DRONABINOL 2.5MG C","code_information":[{"code":"5039","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":12.32,"setting":"both","billing_class":"facility"}]},{"description":"OLANZAPINE 10MG ODT","code_information":[{"code":"5043","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.6,"discounted_cash":13.8,"setting":"both","billing_class":"facility"}]},{"description":"HCTZ 12.5 C","code_information":[{"code":"5049","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"PRAVASTATIN 40MG T","code_information":[{"code":"5050","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.95,"discounted_cash":4.47,"setting":"both","billing_class":"facility"}]},{"description":"ERYTHROMY OO 3.25GM","code_information":[{"code":"5052","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.75,"discounted_cash":19.38,"setting":"both","billing_class":"facility"}]},{"description":"MINOCYCL 100MG T","code_information":[{"code":"5057","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.17,"setting":"both","billing_class":"facility"}]},{"description":"CIPROF OS 0.3% 2.5ML","code_information":[{"code":"5064","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.6,"discounted_cash":31.3,"setting":"both","billing_class":"facility"}]},{"description":"PEG/ELECTR 4000ML","code_information":[{"code":"5070","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.3,"discounted_cash":30.65,"setting":"both","billing_class":"facility"}]},{"description":"CARBAMZ 100MG T","code_information":[{"code":"5077","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"HPP GEL DIFF EA","code_information":[{"code":"508","type":"CDM"},{"code":"300","type":"RC"},{"code":"86331","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.35,"discounted_cash":26.68,"setting":"both","billing_class":"facility"}]},{"description":"VERAPAMIL40MG T","code_information":[{"code":"5081","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"HIV PROPHYLAX KIT 2","code_information":[{"code":"5088","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":103.5,"setting":"both","billing_class":"facility"}]},{"description":"HPP ASPERGILLUS AB","code_information":[{"code":"509","type":"CDM"},{"code":"300","type":"RC"},{"code":"86606","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":51.95,"discounted_cash":25.98,"setting":"both","billing_class":"facility"}]},{"description":"BAC POLY B OO","code_information":[{"code":"5091","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.35,"discounted_cash":36.17,"setting":"both","billing_class":"facility"}]},{"description":"ETHYL CHL SPY  3.5OZ","code_information":[{"code":"5092","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":6.13,"setting":"both","billing_class":"facility"}]},{"description":"LVL 1 EST O/P VISIT","code_information":[{"code":"51","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":383.95,"discounted_cash":191.97,"setting":"both","billing_class":"facility"}]},{"description":"HPP BACTERIUM AB NES","code_information":[{"code":"510","type":"CDM"},{"code":"300","type":"RC"},{"code":"86609","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.3,"discounted_cash":20.65,"setting":"both","billing_class":"facility"}]},{"description":"ISOSORBIDE M 30MG T","code_information":[{"code":"5100","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.05,"setting":"both","billing_class":"facility"}]},{"description":"PROMETH/COD 5ML","code_information":[{"code":"5102","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"ISRP ALBUMIN UR/OTS","code_information":[{"code":"511","type":"CDM"},{"code":"300","type":"RC"},{"code":"82042","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.6,"discounted_cash":18.8,"setting":"both","billing_class":"facility"}]},{"description":"GAVISCON LIQ 12OZ","code_information":[{"code":"5110","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":3.42,"setting":"both","billing_class":"facility"}]},{"description":"TORSEMIDE 100MG T","code_information":[{"code":"5114","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility"}]},{"description":"ISRP ALBUMIN SERUM","code_information":[{"code":"512","type":"CDM"},{"code":"300","type":"RC"},{"code":"82040","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCORT ENEMA 100M","code_information":[{"code":"5123","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":39.4,"discounted_cash":19.7,"setting":"both","billing_class":"facility"}]},{"description":"BENZO 20% OINT","code_information":[{"code":"5124","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.45,"discounted_cash":7.22,"setting":"both","billing_class":"facility"}]},{"description":"GLIMEPIRIDE 1MG T","code_information":[{"code":"5126","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.5,"setting":"both","billing_class":"facility"}]},{"description":"ISRP IGA/IGG/IGM EA","code_information":[{"code":"513","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.35,"discounted_cash":26.68,"setting":"both","billing_class":"facility"}]},{"description":"DIPHENHYD CR 2%","code_information":[{"code":"5130","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":6.25,"setting":"both","billing_class":"facility"}]},{"description":"CARMOL 10% LOT","code_information":[{"code":"5133","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.85,"discounted_cash":32.42,"setting":"both","billing_class":"facility"}]},{"description":"BENZ/METH 6%/10% LOZ","code_information":[{"code":"5134","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.53,"setting":"both","billing_class":"facility"}]},{"description":"NEO BAC PMX OINT 30G","code_information":[{"code":"5139","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":5.63,"setting":"both","billing_class":"facility"}]},{"description":"CTP TISS CULT SKN/BX","code_information":[{"code":"514","type":"CDM"},{"code":"300","type":"RC"},{"code":"88233","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":363.6,"discounted_cash":181.8,"setting":"both","billing_class":"facility"}]},{"description":"CTP CHRM ANLYS 15-20","code_information":[{"code":"515","type":"CDM"},{"code":"300","type":"RC"},{"code":"88262","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":347.85,"discounted_cash":173.93,"setting":"both","billing_class":"facility"}]},{"description":"CTP CYTO/MOLEC RPT","code_information":[{"code":"516","type":"CDM"},{"code":"300","type":"RC"},{"code":"88291","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":347.85,"discounted_cash":173.93,"setting":"both","billing_class":"facility"}]},{"description":"BENZO 20% GEL","code_information":[{"code":"5164","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.55,"discounted_cash":8.78,"setting":"both","billing_class":"facility"}]},{"description":"LEVOFLOX OS .5% 5ML","code_information":[{"code":"5170","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":259.15,"discounted_cash":129.57,"setting":"both","billing_class":"facility"}]},{"description":"CYANCOBAL 100MCG T","code_information":[{"code":"5174","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.48,"setting":"both","billing_class":"facility"}]},{"description":"DIVALPROEX ER 500MG","code_information":[{"code":"5181","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.55,"discounted_cash":6.28,"setting":"both","billing_class":"facility"}]},{"description":"DIVALPRO SPRNKL 125M","code_information":[{"code":"5182","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.7,"discounted_cash":1.85,"setting":"both","billing_class":"facility"}]},{"description":"PILOCARPINE 5MG TAB","code_information":[{"code":"5183","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.7,"discounted_cash":1.85,"setting":"both","billing_class":"facility"}]},{"description":"DEX/GUAIF 30/600 TAB","code_information":[{"code":"5185","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.05,"setting":"both","billing_class":"facility"}]},{"description":"APPL UNNA BOOT RT","code_information":[{"code":"52","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.05,"discounted_cash":227.53,"setting":"both","billing_class":"facility"}]},{"description":"TWO CAL HN","code_information":[{"code":"5202","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.3,"discounted_cash":15.65,"setting":"both","billing_class":"facility"}]},{"description":"BVVP TRICHOMONAS","code_information":[{"code":"521","type":"CDM"},{"code":"300","type":"RC"},{"code":"87660","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":55.0,"setting":"both","billing_class":"facility"}]},{"description":"CALCIUM CARB 500MG T","code_information":[{"code":"5210","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.48,"setting":"both","billing_class":"facility"}]},{"description":"MULTI VIT TAB","code_information":[{"code":"5211","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"BVVP GARDNERELLA","code_information":[{"code":"522","type":"CDM"},{"code":"300","type":"RC"},{"code":"87510","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":55.0,"setting":"both","billing_class":"facility"}]},{"description":"NEO BAC PMX ONT PCKT","code_information":[{"code":"5227","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.53,"setting":"both","billing_class":"facility"}]},{"description":"VIT D3 1000IU","code_information":[{"code":"5229","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"BVVP CANDIDA","code_information":[{"code":"523","type":"CDM"},{"code":"300","type":"RC"},{"code":"87480","type":"CPT"},{"code":"683","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":55.0,"setting":"both","billing_class":"facility"}]},{"description":"LAMOTRIGINE 100MG T","code_information":[{"code":"5232","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.43,"setting":"both","billing_class":"facility"}]},{"description":"TIAGABINE 4MG TAB","code_information":[{"code":"5233","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.85,"discounted_cash":7.42,"setting":"both","billing_class":"facility"}]},{"description":"MIDODRINE 2.5MG TAB","code_information":[{"code":"5238","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.5,"setting":"both","billing_class":"facility"}]},{"description":"LEVETIRACETAM 250MG","code_information":[{"code":"5240","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.45,"setting":"both","billing_class":"facility"}]},{"description":"FORMOT PWD 12MCG/12C","code_information":[{"code":"5246","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":141.95,"discounted_cash":70.97,"setting":"both","billing_class":"facility"}]},{"description":"ISOSORBIDE DN 40MG T","code_information":[{"code":"5270","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":2.33,"setting":"both","billing_class":"facility"}]},{"description":"ISOSORBIDE DN 10MG T","code_information":[{"code":"5271","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":1.02,"setting":"both","billing_class":"facility"}]},{"description":"PRED/GENT 1% OS 5ML","code_information":[{"code":"5277","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":220.85,"discounted_cash":110.42,"setting":"both","billing_class":"facility"}]},{"description":"DAKINS SOL FS 480ML","code_information":[{"code":"5280","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.65,"discounted_cash":17.82,"setting":"both","billing_class":"facility"}]},{"description":"DAKINS SOL 1/4S 480","code_information":[{"code":"5281","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.65,"discounted_cash":17.82,"setting":"both","billing_class":"facility"}]},{"description":"LETROZOLE 2.5MG T","code_information":[{"code":"5286","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0166","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.55,"discounted_cash":26.27,"setting":"both","billing_class":"facility"}]},{"description":"MELATONIN 5 MG TAB","code_information":[{"code":"5289","type":"CDM"},{"code":"637","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.55,"setting":"both","billing_class":"facility"}]},{"description":"GLIPIZIDE XL 2.5MG T","code_information":[{"code":"5294","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"APPL UNNA BOOT LT","code_information":[{"code":"53","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.05,"discounted_cash":227.53,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCOD/APAP 5/325T","code_information":[{"code":"5301","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"PROM/PHEN VC 5ML SYR","code_information":[{"code":"5303","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.27,"setting":"both","billing_class":"facility"}]},{"description":"ZONISAMIDE 100MG C","code_information":[{"code":"5307","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":2.08,"setting":"both","billing_class":"facility"}]},{"description":"OXCARBAZEP 300MG T","code_information":[{"code":"5311","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":2.55,"setting":"both","billing_class":"facility"}]},{"description":"AQUAPHOR OINT 52.5GM","code_information":[{"code":"5312","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.05,"discounted_cash":8.53,"setting":"both","billing_class":"facility"}]},{"description":"DDAVP 0.2MG T","code_information":[{"code":"5318","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8522","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility"}]},{"description":"PREGABALIN 25MG C","code_information":[{"code":"5327","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8522","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.9,"discounted_cash":7.95,"setting":"both","billing_class":"facility"}]},{"description":"PREGABALIN 100MG C","code_information":[{"code":"5328","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8522","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.9,"discounted_cash":9.45,"setting":"both","billing_class":"facility"}]},{"description":"CALCITON 200/3.7MLNS","code_information":[{"code":"5356","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8522","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":222.85,"discounted_cash":111.42,"setting":"both","billing_class":"facility"}]},{"description":"JEVITY 1 CAL RTH 1L","code_information":[{"code":"5365","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8522","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.3,"discounted_cash":15.65,"setting":"both","billing_class":"facility"}]},{"description":"VITAL 1.5 CAL 237ML","code_information":[{"code":"5369","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8522","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":11.25,"setting":"both","billing_class":"facility"}]},{"description":"PEGFIL CBQV 0.5(6MG)","code_information":[{"code":"5370","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5111","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":709.97,"discounted_cash":354.99,"setting":"both","billing_class":"facility"}]},{"description":"VEDOLIZUMAB 300MG IN","code_information":[{"code":"5371","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3380","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.41,"discounted_cash":23.7,"setting":"both","billing_class":"facility"}]},{"description":"SOTRADECOL 3% 2 ML","code_information":[{"code":"5372","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":234.7,"discounted_cash":117.35,"setting":"both","billing_class":"facility"}]},{"description":"NA-K-PHOS 250 MG T","code_information":[{"code":"5375","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.27,"setting":"both","billing_class":"facility"}]},{"description":"AMOX/CLAV 600 SUSP","code_information":[{"code":"5380","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.75,"discounted_cash":47.88,"setting":"both","billing_class":"facility"}]},{"description":"PAROXETIN CR 12.5MG","code_information":[{"code":"5381","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":5.22,"setting":"both","billing_class":"facility"}]},{"description":"SERTRALINE 25MG T","code_information":[{"code":"5390","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":2.52,"setting":"both","billing_class":"facility"}]},{"description":"APPL UNNA BOOT BILAT","code_information":[{"code":"54","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":766.2,"discounted_cash":383.1,"setting":"both","billing_class":"facility"}]},{"description":"CYCLOSPOR SUSP 50ML","code_information":[{"code":"5400","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.47,"discounted_cash":10.73,"setting":"both","billing_class":"facility"}]},{"description":"OLMESARTAN 20MG T","code_information":[{"code":"5402","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":5.88,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCOD/APAP7.5/325","code_information":[{"code":"5405","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.18,"setting":"both","billing_class":"facility"}]},{"description":"CARBAMAZ 100/5 5ML","code_information":[{"code":"5416","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"BALSALAZIDE 750MG C","code_information":[{"code":"5420","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.48,"setting":"both","billing_class":"facility"}]},{"description":"ESCITALOPRAM 10MG T","code_information":[{"code":"5425","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.3,"discounted_cash":4.15,"setting":"both","billing_class":"facility"}]},{"description":"NICOTINE INH CART","code_information":[{"code":"5427","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":17.38,"setting":"both","billing_class":"facility"}]},{"description":"ORPHEN ER 100MG T","code_information":[{"code":"5431","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":1.95,"setting":"both","billing_class":"facility"}]},{"description":"MOEXIPRIL 15MG T","code_information":[{"code":"5434","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"ALB/IPRAT 3MG/.5MG","code_information":[{"code":"5453","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.15,"discounted_cash":3.58,"setting":"both","billing_class":"facility"}]},{"description":"CETIRIZ/PSEU 5/120 T","code_information":[{"code":"5458","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"ASA/APAP/CAFF","code_information":[{"code":"5459","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"PRAMIPEX 0.5MG T","code_information":[{"code":"5468","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":3.08,"setting":"both","billing_class":"facility"}]},{"description":"TAMIFLU 6MG/ML SUSP","code_information":[{"code":"5475","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.35,"discounted_cash":4.67,"setting":"both","billing_class":"facility"}]},{"description":"PIMECROLIMUS 1% CR","code_information":[{"code":"5476","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":674.2,"discounted_cash":337.1,"setting":"both","billing_class":"facility"}]},{"description":"ARIPIPRAZOLE 10MG T","code_information":[{"code":"5477","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.2,"discounted_cash":30.1,"setting":"both","billing_class":"facility"}]},{"description":"SOD FERR GLUC 12.5MG","code_information":[{"code":"5482","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.07,"discounted_cash":9.54,"setting":"both","billing_class":"facility"}]},{"description":"PSYLLIUM SF PKT","code_information":[{"code":"5485","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.8,"setting":"both","billing_class":"facility"}]},{"description":"MAGIC MWASH 240ML","code_information":[{"code":"5491","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":112.55,"discounted_cash":56.27,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE IR 15MG T","code_information":[{"code":"5496","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.65,"setting":"both","billing_class":"facility"}]},{"description":"INTUBATION PKT","code_information":[{"code":"5497","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"APP MLTL COMP LWR LG","code_information":[{"code":"55","type":"CDM"},{"code":"761","type":"RC"},{"code":"29581","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.05,"discounted_cash":227.53,"setting":"both","billing_class":"facility"}]},{"description":"CEFADROXIL 250/5 5ML","code_information":[{"code":"5505","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":3.42,"setting":"both","billing_class":"facility"}]},{"description":"DIMETAPP ELIXIR","code_information":[{"code":"5517","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.43,"setting":"both","billing_class":"facility"}]},{"description":"CAFFEINE 200MG T","code_information":[{"code":"5531","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"TENOFOVIR DF 300MG T","code_information":[{"code":"5537","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility"}]},{"description":"ACET 650MG/20.3 SUSP","code_information":[{"code":"5539","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.1,"discounted_cash":3.55,"setting":"both","billing_class":"facility"}]},{"description":"ACET/COD ELIX 12.5ML","code_information":[{"code":"5540","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility"}]},{"description":"CHLOROTHIAZ 250MG T","code_information":[{"code":"5541","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"BUDESONIDE 3MG C","code_information":[{"code":"5552","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.4,"discounted_cash":17.7,"setting":"both","billing_class":"facility"}]},{"description":"BENAZ/HCTZ 20/12.5 T","code_information":[{"code":"5558","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.3,"discounted_cash":2.15,"setting":"both","billing_class":"facility"}]},{"description":"AMOL/BENAZ 2.5/10MGC","code_information":[{"code":"5581","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":2.85,"setting":"both","billing_class":"facility"}]},{"description":"AMOX/KCLAV 200/5 75M","code_information":[{"code":"5582","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"CLARITH 250/5 50ML","code_information":[{"code":"5585","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.65,"discounted_cash":15.32,"setting":"both","billing_class":"facility"}]},{"description":"EZETIMIBE 10MG T","code_information":[{"code":"5590","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.05,"discounted_cash":13.03,"setting":"both","billing_class":"facility"}]},{"description":"A&D OINT 5GM U/D","code_information":[{"code":"5594","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":3.42,"setting":"both","billing_class":"facility"}]},{"description":"BELLADON 16.2/5 60ML","code_information":[{"code":"5599","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.7,"discounted_cash":27.85,"setting":"both","billing_class":"facility"}]},{"description":"NEG PRES WND TX <50","code_information":[{"code":"56","type":"CDM"},{"code":"761","type":"RC"},{"code":"97605","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":556.6,"discounted_cash":278.3,"setting":"both","billing_class":"facility"}]},{"description":"AZITHRO 200/5 30ML","code_information":[{"code":"5614","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"DIPHEN 12.5/5 5ML","code_information":[{"code":"5618","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":3.85,"setting":"both","billing_class":"facility"}]},{"description":"LOPERAMIDE 120ML","code_information":[{"code":"5620","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.6,"setting":"both","billing_class":"facility"}]},{"description":"DIVALPRO ER 250MG T","code_information":[{"code":"5639","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":2.33,"setting":"both","billing_class":"facility"}]},{"description":"HYDROXYCHLOR 200MG T","code_information":[{"code":"5642","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility"}]},{"description":"TROLAM SAL 10% 60GM","code_information":[{"code":"5643","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":6.25,"setting":"both","billing_class":"facility"}]},{"description":"K PHOS 500 TAB","code_information":[{"code":"5650","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":1.15,"setting":"both","billing_class":"facility"}]},{"description":"IPRATROPIUM BR .02%","code_information":[{"code":"5652","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"AZITHROMYCIN 500MG T","code_information":[{"code":"5667","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.2,"discounted_cash":15.1,"setting":"both","billing_class":"facility"}]},{"description":"LACTOBAC ACIDOPHIL C","code_information":[{"code":"5678","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.53,"setting":"both","billing_class":"facility"}]},{"description":"NYSTATIN OINT 15GM","code_information":[{"code":"5681","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.55,"discounted_cash":26.27,"setting":"both","billing_class":"facility"}]},{"description":"OXYBUTYNIN 3.9MG TDP","code_information":[{"code":"5682","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":191.1,"discounted_cash":95.55,"setting":"both","billing_class":"facility"}]},{"description":"IBUPRO 40MG/ML 15ML","code_information":[{"code":"5699","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":10.63,"setting":"both","billing_class":"facility"}]},{"description":"NEG PRES WND TX >50","code_information":[{"code":"57","type":"CDM"},{"code":"761","type":"RC"},{"code":"97606","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.4,"discounted_cash":487.7,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCORT SUPP 25MG","code_information":[{"code":"5717","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.8,"discounted_cash":26.9,"setting":"both","billing_class":"facility"}]},{"description":"LACTASE 9000U T","code_information":[{"code":"5722","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.43,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCORT 2.5% CR 30","code_information":[{"code":"5726","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":16.88,"setting":"both","billing_class":"facility"}]},{"description":"MURO 128 5% OINT 3.5","code_information":[{"code":"5732","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.05,"discounted_cash":30.02,"setting":"both","billing_class":"facility"}]},{"description":"DOXERCALC 0.5MCG C","code_information":[{"code":"5738","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.55,"discounted_cash":16.27,"setting":"both","billing_class":"facility"}]},{"description":"VIT D 400MG T","code_information":[{"code":"5749","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.38,"setting":"both","billing_class":"facility"}]},{"description":"TOBRA DEX OS 2.5ML","code_information":[{"code":"5757","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.8,"discounted_cash":118.9,"setting":"both","billing_class":"facility"}]},{"description":"SALMET XINA 50MCG 28","code_information":[{"code":"5760","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":187.0,"setting":"both","billing_class":"facility"}]},{"description":"RACEPINEPHRINE SOLN","code_information":[{"code":"5761","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":1.8,"setting":"both","billing_class":"facility"}]},{"description":"TACROLIMUS 0.5MG C","code_information":[{"code":"5788","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.87,"discounted_cash":3.44,"setting":"both","billing_class":"facility"}]},{"description":"SILVER SD 1% CR 50GM","code_information":[{"code":"5795","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.1,"discounted_cash":15.05,"setting":"both","billing_class":"facility"}]},{"description":"NEBIVOLOL 5MG T","code_information":[{"code":"5797","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.1,"discounted_cash":5.05,"setting":"both","billing_class":"facility"}]},{"description":"NITAZOXANIDE 500MG T","code_information":[{"code":"5798","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":255.35,"discounted_cash":127.67,"setting":"both","billing_class":"facility"}]},{"description":"OXY/APAP 5/325MG 5ML","code_information":[{"code":"5799","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility"}]},{"description":"2N OBS DIRECT ADM","code_information":[{"code":"58","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0379","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":1460.95,"discounted_cash":730.48,"setting":"both","billing_class":"facility"}]},{"description":"PARICALCITOL 1MCG T","code_information":[{"code":"5800","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.8,"discounted_cash":9.9,"setting":"both","billing_class":"facility"}]},{"description":"PRASUGREL 10MG T","code_information":[{"code":"5801","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.55,"discounted_cash":17.27,"setting":"both","billing_class":"facility"}]},{"description":"RASAGILINE 1MG T","code_information":[{"code":"5802","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":29.38,"setting":"both","billing_class":"facility"}]},{"description":"RIVAST 9.5MG/24H TDP","code_information":[{"code":"5803","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.1,"discounted_cash":30.55,"setting":"both","billing_class":"facility"}]},{"description":"SITAGLIPTIN 100MG T","code_information":[{"code":"5804","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility"}]},{"description":"SOLIFENACIN 5MG T","code_information":[{"code":"5805","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.8,"discounted_cash":13.9,"setting":"both","billing_class":"facility"}]},{"description":"TOLVAPTAN 30MG T","code_information":[{"code":"5806","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1003.8,"discounted_cash":501.9,"setting":"both","billing_class":"facility"}]},{"description":"VARENICLINE 1MG T","code_information":[{"code":"5807","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":8.13,"setting":"both","billing_class":"facility"}]},{"description":"SYMBICORT 80/4.5MCG","code_information":[{"code":"5808","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":391.35,"discounted_cash":195.68,"setting":"both","billing_class":"facility"}]},{"description":"SYMBICORT 160/4.5MCG","code_information":[{"code":"5809","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":450.7,"discounted_cash":225.35,"setting":"both","billing_class":"facility"}]},{"description":"PAIN EASE PER DOSE","code_information":[{"code":"5810","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"MIDRIN CAP","code_information":[{"code":"5820","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":6.47,"setting":"both","billing_class":"facility"}]},{"description":"VISICOL PREP TAB BTL","code_information":[{"code":"5821","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":5.8,"setting":"both","billing_class":"facility"}]},{"description":"MOXIFLOX .5% OS 3ML","code_information":[{"code":"5826","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":370.6,"discounted_cash":185.3,"setting":"both","billing_class":"facility"}]},{"description":"DICLOFEN .1% OS 2.5M","code_information":[{"code":"5828","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":112.65,"discounted_cash":56.33,"setting":"both","billing_class":"facility"}]},{"description":"LEVALBUT 1.25/0.5ML","code_information":[{"code":"5840","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.55,"discounted_cash":6.28,"setting":"both","billing_class":"facility"}]},{"description":"CREON 20 CAP","code_information":[{"code":"5857","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":7.38,"setting":"both","billing_class":"facility"}]},{"description":"DIATRIZ MEGLU 120ML","code_information":[{"code":"5860","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.45,"discounted_cash":27.23,"setting":"both","billing_class":"facility"}]},{"description":"DOCUSATE NA 100/10ML","code_information":[{"code":"5867","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCORT 5MG T","code_information":[{"code":"5868","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"CEFUROX 250/5 50ML","code_information":[{"code":"5894","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.35,"discounted_cash":4.67,"setting":"both","billing_class":"facility"}]},{"description":"ERGOCALC 50000 U C","code_information":[{"code":"5897","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.65,"discounted_cash":1.83,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD ADMINISTRATION","code_information":[{"code":"59","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":855.7,"discounted_cash":427.85,"setting":"both","billing_class":"facility"}]},{"description":"BUPROPRIO XL 150MG T","code_information":[{"code":"5902","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.85,"discounted_cash":4.92,"setting":"both","billing_class":"facility"}]},{"description":"ROSUVASTATIN 20MG T","code_information":[{"code":"5904","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.6,"discounted_cash":9.8,"setting":"both","billing_class":"facility"}]},{"description":"POT CIT 10 MEQ T","code_information":[{"code":"5906","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":2.55,"setting":"both","billing_class":"facility"}]},{"description":"FLUTIC PRO 44/13 A","code_information":[{"code":"5910","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":409.4,"discounted_cash":204.7,"setting":"both","billing_class":"facility"}]},{"description":"FLUTIC PRO 110/13 A","code_information":[{"code":"5911","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":564.6,"discounted_cash":282.3,"setting":"both","billing_class":"facility"}]},{"description":"ALFUZOSIN 10MG T","code_information":[{"code":"5917","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":3.88,"setting":"both","billing_class":"facility"}]},{"description":"ICU R&B","code_information":[{"code":"592","type":"CDM"},{"code":"200","type":"RC"},{"code":"86003","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":4000.0,"discounted_cash":2000.0,"setting":"both","billing_class":"facility"}]},{"description":"CHARC ACT AQ 50 GM","code_information":[{"code":"5923","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.7,"discounted_cash":29.85,"setting":"both","billing_class":"facility"}]},{"description":"CIP/DEX OTIC SOL 7.5","code_information":[{"code":"5925","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":451.95,"discounted_cash":225.97,"setting":"both","billing_class":"facility"}]},{"description":"MEMANTINE 5MG T","code_information":[{"code":"5927","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":5.67,"setting":"both","billing_class":"facility"}]},{"description":"METAXALONE 800MG T","code_information":[{"code":"5928","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":11.38,"setting":"both","billing_class":"facility"}]},{"description":"GLUCERNA SELCT 240ML","code_information":[{"code":"5941","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.3,"discounted_cash":2.15,"setting":"both","billing_class":"facility"}]},{"description":"RISPERIDON M 0.5MG T","code_information":[{"code":"5942","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":4.13,"setting":"both","billing_class":"facility"}]},{"description":"XENADERM 60GM","code_information":[{"code":"5946","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility"}]},{"description":"MS TELEMETRY OVRFLW","code_information":[{"code":"595","type":"CDM"},{"code":"206","type":"RC"},{"code":"92960","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":2548.5,"discounted_cash":1274.25,"setting":"both","billing_class":"facility"}]},{"description":"LAMIV/ZIDO 150/300 T","code_information":[{"code":"5952","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.2,"discounted_cash":14.6,"setting":"both","billing_class":"facility"}]},{"description":"ACYCLOVIR 400MG T","code_information":[{"code":"5957","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":1.8,"setting":"both","billing_class":"facility"}]},{"description":"ROSUVASTATIN 5MG T","code_information":[{"code":"5958","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.6,"discounted_cash":9.8,"setting":"both","billing_class":"facility"}]},{"description":"ICU OBS 1ST HR","code_information":[{"code":"596","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":880.57,"discounted_cash":440.29,"setting":"both","billing_class":"facility"}]},{"description":"TRIMETHOBENZ 300MG C","code_information":[{"code":"5963","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":5.13,"setting":"both","billing_class":"facility"}]},{"description":"CYANOCOBAL 1000MCG T","code_information":[{"code":"5968","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"ICU OBS ADD HR","code_information":[{"code":"597","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":128.75,"setting":"both","billing_class":"facility"}]},{"description":"PENCICLOVIR 1% 1.5GM","code_information":[{"code":"5973","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.35,"discounted_cash":113.67,"setting":"both","billing_class":"facility"}]},{"description":"SILDENAFIL CIT 20MGT","code_information":[{"code":"5976","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.55,"discounted_cash":18.77,"setting":"both","billing_class":"facility"}]},{"description":"XENADERM OINT 30GM","code_information":[{"code":"5977","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":81.8,"discounted_cash":40.9,"setting":"both","billing_class":"facility"}]},{"description":"ICU OBS DIRECT ADMIT","code_information":[{"code":"598","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0379","type":"HCPCS"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":1887.95,"discounted_cash":943.98,"setting":"both","billing_class":"facility"}]},{"description":"MEGESTER 400MG/10ML","code_information":[{"code":"5981","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.3,"discounted_cash":6.65,"setting":"both","billing_class":"facility"}]},{"description":"FOLBEE PLUS TAB","code_information":[{"code":"5991","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility"}]},{"description":"SILDENAFIL 25MG T","code_information":[{"code":"5998","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.7,"discounted_cash":39.35,"setting":"both","billing_class":"facility"}]},{"description":"IMMUN ADMIN 1ST VACC","code_information":[{"code":"60","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":90.85,"discounted_cash":45.42,"setting":"both","billing_class":"facility"}]},{"description":"BLOOD ADMINISTRATION","code_information":[{"code":"600","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.21,"discounted_cash":447.11,"setting":"both","billing_class":"facility"}]},{"description":"CHERRY SYRUP 5ML","code_information":[{"code":"6004","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 250/5 SYR","code_information":[{"code":"6005","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.95,"discounted_cash":33.48,"setting":"both","billing_class":"facility"}]},{"description":"IMMUN ADMIN 1ST VACC","code_information":[{"code":"601","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.94,"discounted_cash":47.47,"setting":"both","billing_class":"facility"}]},{"description":"SENOKOT TABLET","code_information":[{"code":"6011","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility"}]},{"description":"GUAIF/CODEINE 10ML","code_information":[{"code":"6018","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"IV INF HYDR INTL HR","code_information":[{"code":"603","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":294.1,"discounted_cash":147.05,"setting":"both","billing_class":"facility"}]},{"description":"IV INF HYDR ADDL HR","code_information":[{"code":"604","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.3,"discounted_cash":26.65,"setting":"both","billing_class":"facility"}]},{"description":"TRIAM 0.1% OINT 15GM","code_information":[{"code":"6047","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.55,"discounted_cash":8.78,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX 1 HR","code_information":[{"code":"605","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":294.1,"discounted_cash":147.05,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX ADDL HR","code_information":[{"code":"606","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility"}]},{"description":"TERBINAF 1% CR 30GM","code_information":[{"code":"6060","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.55,"discounted_cash":18.77,"setting":"both","billing_class":"facility"}]},{"description":"FLUOCIN CR 0.05% 30G","code_information":[{"code":"6063","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":251.2,"discounted_cash":125.6,"setting":"both","billing_class":"facility"}]},{"description":"CLOTRIM/BETA CR 45GM","code_information":[{"code":"6065","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":108.9,"discounted_cash":54.45,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX SEQ 1HR","code_information":[{"code":"607","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":166.1,"discounted_cash":83.05,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX CONCRNT","code_information":[{"code":"608","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":90.85,"discounted_cash":45.42,"setting":"both","billing_class":"facility"}]},{"description":"AYR GEL","code_information":[{"code":"6083","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.05,"discounted_cash":8.53,"setting":"both","billing_class":"facility"}]},{"description":"INJ IM/SQ","code_information":[{"code":"609","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":53.88,"setting":"both","billing_class":"facility"}]},{"description":"PETROLATUM JELLY 5G","code_information":[{"code":"6093","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"IMMUN ADMIN ADD VACC","code_information":[{"code":"61","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":21.2,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP SGL/INT SUBS","code_information":[{"code":"610","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":278.95,"discounted_cash":139.47,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP ADD/SEQ SUBS","code_information":[{"code":"611","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.5,"discounted_cash":79.25,"setting":"both","billing_class":"facility"}]},{"description":"BRIMONIDINE 0.15% 5M","code_information":[{"code":"6111","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":363.95,"discounted_cash":181.97,"setting":"both","billing_class":"facility"}]},{"description":"SULF/PRED 0.2% OS 5M","code_information":[{"code":"6112","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.8,"discounted_cash":29.4,"setting":"both","billing_class":"facility"}]},{"description":"GELFILM EYE PKT","code_information":[{"code":"6118","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":504.3,"discounted_cash":252.15,"setting":"both","billing_class":"facility"}]},{"description":"ADMIN INFLUENZA VACC","code_information":[{"code":"612","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.65,"discounted_cash":34.83,"setting":"both","billing_class":"facility"}]},{"description":"ADMIN PNEUMO VACC","code_information":[{"code":"613","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.46,"discounted_cash":36.73,"setting":"both","billing_class":"facility"}]},{"description":"CARBACHOL 0.01% 1.5M","code_information":[{"code":"6131","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":101.35,"discounted_cash":50.67,"setting":"both","billing_class":"facility"}]},{"description":"FERRIC SUBS SOLN 8ML","code_information":[{"code":"6139","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.05,"discounted_cash":30.02,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP SAME SUBS","code_information":[{"code":"614","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":183.8,"discounted_cash":91.9,"setting":"both","billing_class":"facility"}]},{"description":"DULOXETINE 30MG C","code_information":[{"code":"6145","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.8,"discounted_cash":7.4,"setting":"both","billing_class":"facility"}]},{"description":"UROQUID TAB","code_information":[{"code":"6157","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.45,"setting":"both","billing_class":"facility"}]},{"description":"EEG 41-60 MINUTES","code_information":[{"code":"616","type":"CDM"},{"code":"740","type":"RC"},{"code":"95812","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":922.11,"discounted_cash":461.06,"setting":"both","billing_class":"facility"}]},{"description":"PHENYLEPH 0.5% 15ML","code_information":[{"code":"6164","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":5.92,"setting":"both","billing_class":"facility"}]},{"description":"PHENYLEPH 0.25% 15ML","code_information":[{"code":"6165","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":5.92,"setting":"both","billing_class":"facility"}]},{"description":"PIRBUTEROL 14G AER","code_information":[{"code":"6168","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1633.25,"discounted_cash":816.63,"setting":"both","billing_class":"facility"}]},{"description":"EEG EXTND MNTR 61-1","code_information":[{"code":"617","type":"CDM"},{"code":"740","type":"RC"},{"code":"95813","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":968.3,"discounted_cash":484.15,"setting":"both","billing_class":"facility"}]},{"description":"OXEPA RTH 1L","code_information":[{"code":"6174","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":118.95,"discounted_cash":59.48,"setting":"both","billing_class":"facility"}]},{"description":"DULOXETINE 20MG C","code_information":[{"code":"6178","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.89,"discounted_cash":6.95,"setting":"both","billing_class":"facility"}]},{"description":"EEG W/O VID 2-12HR C","code_information":[{"code":"618","type":"CDM"},{"code":"740","type":"RC"},{"code":"95707","type":"CPT"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":968.3,"discounted_cash":484.15,"setting":"both","billing_class":"facility"}]},{"description":"ONDANSETRON ODT 4MGT","code_information":[{"code":"6183","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":5.2,"setting":"both","billing_class":"facility"}]},{"description":"CYCLOSPORIN 0.05% OS","code_information":[{"code":"6190","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.35,"discounted_cash":10.18,"setting":"both","billing_class":"facility"}]},{"description":"VALSARTAN 80MG T","code_information":[{"code":"6191","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":7.63,"setting":"both","billing_class":"facility"}]},{"description":"IV INF HYDR INTL HR","code_information":[{"code":"62","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":281.2,"discounted_cash":140.6,"setting":"both","billing_class":"facility"}]},{"description":"OP BLADDER IRIG/LAVG","code_information":[{"code":"620","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"411","type":"LOCAL"}],"standard_charges":[{"gross_charge":448.15,"discounted_cash":224.07,"setting":"both","billing_class":"facility"}]},{"description":"FENOFIBRATE 48MG T","code_information":[{"code":"6200","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":1.8,"setting":"both","billing_class":"facility"}]},{"description":"FENOFIBRATE 145MG T","code_information":[{"code":"6201","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":5.5,"setting":"both","billing_class":"facility"}]},{"description":"GLUCERNA RTH 1L","code_information":[{"code":"6204","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.25,"discounted_cash":31.63,"setting":"both","billing_class":"facility"}]},{"description":"JUVEN PACK","code_information":[{"code":"6213","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":3.88,"setting":"both","billing_class":"facility"}]},{"description":"ACETYLCYST 10% 4ML","code_information":[{"code":"6215","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.3,"discounted_cash":15.65,"setting":"both","billing_class":"facility"}]},{"description":"METHACHOL PER1MG NEB","code_information":[{"code":"6223","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.59,"setting":"both","billing_class":"facility"}]},{"description":"RIFAXIMIN 200MG TAB","code_information":[{"code":"6230","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.6,"discounted_cash":23.3,"setting":"both","billing_class":"facility"}]},{"description":"THROMBI GEL 100","code_information":[{"code":"6234","type":"CDM"},{"code":"272","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":292.15,"discounted_cash":146.07,"setting":"both","billing_class":"facility"}]},{"description":"HEMOST GELFOAM 12-7","code_information":[{"code":"6236","type":"CDM"},{"code":"272","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.4,"discounted_cash":9.2,"setting":"both","billing_class":"facility"}]},{"description":"OB PRIVATE","code_information":[{"code":"624","type":"CDM"},{"code":"112","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"412","type":"LOCAL"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1200.0,"setting":"both","billing_class":"facility"}]},{"description":"HEMOST SURGICEL 2X3","code_information":[{"code":"6243","type":"CDM"},{"code":"272","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":205.75,"discounted_cash":102.88,"setting":"both","billing_class":"facility"}]},{"description":"OB SEMI-PVT","code_information":[{"code":"625","type":"CDM"},{"code":"122","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"412","type":"LOCAL"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1200.0,"setting":"both","billing_class":"facility"}]},{"description":"LIDO VISC 2% 100ML","code_information":[{"code":"6251","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"DEEP SEA NS SPRY 45M","code_information":[{"code":"6254","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":6.25,"setting":"both","billing_class":"facility"}]},{"description":"DERMOPLAST SPRY 60GM","code_information":[{"code":"6255","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.2,"discounted_cash":8.6,"setting":"both","billing_class":"facility"}]},{"description":"DIPHENYHYDRAM 25MG T","code_information":[{"code":"6263","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility"}]},{"description":"MVI LIQ 15ML","code_information":[{"code":"6264","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"TALC ST 4GM AER","code_information":[{"code":"6265","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":273.85,"discounted_cash":136.93,"setting":"both","billing_class":"facility"}]},{"description":"DARIF HYD SR 7.5 MGT","code_information":[{"code":"6276","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":13.63,"setting":"both","billing_class":"facility"}]},{"description":"ACET 100/ML 15ML DPS","code_information":[{"code":"6279","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.27,"setting":"both","billing_class":"facility"}]},{"description":"NIX CR RINSE 1% 2OZ","code_information":[{"code":"6288","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.2,"discounted_cash":9.1,"setting":"both","billing_class":"facility"}]},{"description":"CARB/LEVO 25/100 SRT","code_information":[{"code":"6290","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":1.52,"setting":"both","billing_class":"facility"}]},{"description":"CINACALCET 30MG T","code_information":[{"code":"6299","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.55,"discounted_cash":30.27,"setting":"both","billing_class":"facility"}]},{"description":"IV INF HYDR ADDL HR","code_information":[{"code":"63","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.85,"discounted_cash":25.43,"setting":"both","billing_class":"facility"}]},{"description":"FOLIC ACID 400MCG T","code_information":[{"code":"6301","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.43,"setting":"both","billing_class":"facility"}]},{"description":"TIOTROPIUM BROM KIT","code_information":[{"code":"6319","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility"}]},{"description":"DUTASTERIDE 0.5MG C","code_information":[{"code":"6324","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.85,"discounted_cash":7.42,"setting":"both","billing_class":"facility"}]},{"description":"VORICONAZOLE 200MG T","code_information":[{"code":"6330","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":149.25,"discounted_cash":74.63,"setting":"both","billing_class":"facility"}]},{"description":"DONNATAL EXTENTAB","code_information":[{"code":"6359","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.45,"discounted_cash":8.72,"setting":"both","billing_class":"facility"}]},{"description":"FLUTIC/SALMET 500MCG","code_information":[{"code":"6360","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.15,"discounted_cash":29.57,"setting":"both","billing_class":"facility"}]},{"description":"PREDNISOL 1% OS 10ML","code_information":[{"code":"6378","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.55,"discounted_cash":120.28,"setting":"both","billing_class":"facility"}]},{"description":"CAPSAIC CR 0.025% 60","code_information":[{"code":"6379","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.2,"discounted_cash":28.6,"setting":"both","billing_class":"facility"}]},{"description":"PSYCH SEMI-PRIVATE","code_information":[{"code":"638","type":"CDM"},{"code":"124","type":"RC"},{"code":"412","type":"LOCAL"}],"standard_charges":[{"gross_charge":2020.4,"discounted_cash":1010.2,"setting":"both","billing_class":"facility"}]},{"description":"MOMETAS 110MCG/INH","code_information":[{"code":"6380","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.3,"discounted_cash":24.65,"setting":"both","billing_class":"facility"}]},{"description":"DSG PETROLAT GZ 4X4","code_information":[{"code":"6381","type":"CDM"},{"code":"272","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.05,"discounted_cash":3.02,"setting":"both","billing_class":"facility"}]},{"description":"LACOSAMIDE 50MG T","code_information":[{"code":"6383","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.4,"discounted_cash":10.2,"setting":"both","billing_class":"facility"}]},{"description":"IVERMECTIN 3MG T","code_information":[{"code":"6384","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":5.22,"setting":"both","billing_class":"facility"}]},{"description":"ISATUXIMB IRFC 10MG","code_information":[{"code":"6385","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":149.96,"discounted_cash":74.98,"setting":"both","billing_class":"facility"}]},{"description":"PSYCH PRIVATE","code_information":[{"code":"639","type":"CDM"},{"code":"114","type":"RC"},{"code":"412","type":"LOCAL"}],"standard_charges":[{"gross_charge":2814.1,"discounted_cash":1407.05,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX 1 HR","code_information":[{"code":"64","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":281.2,"discounted_cash":140.6,"setting":"both","billing_class":"facility"}]},{"description":"PREGABALIN 150MG C","code_information":[{"code":"6400","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":8.5,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCORT 1% CR 30GM","code_information":[{"code":"6414","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":7.53,"setting":"both","billing_class":"facility"}]},{"description":"LANSOPRAZ 30MG ODT","code_information":[{"code":"6416","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":15.63,"setting":"both","billing_class":"facility"}]},{"description":"THEOPH 300MG SRC 24","code_information":[{"code":"6425","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":2.75,"setting":"both","billing_class":"facility"}]},{"description":"KLOR CON 20MEQ T","code_information":[{"code":"6427","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.18,"setting":"both","billing_class":"facility"}]},{"description":"POT CL 10% LIQ 15ML","code_information":[{"code":"6428","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.3,"discounted_cash":29.15,"setting":"both","billing_class":"facility"}]},{"description":"RANOLAZINE 500MG XRT","code_information":[{"code":"6429","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":6.75,"setting":"both","billing_class":"facility"}]},{"description":"VENTOLIN 90MCG/8GM","code_information":[{"code":"6431","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.1,"discounted_cash":24.55,"setting":"both","billing_class":"facility"}]},{"description":"VITAMIN B6 100MG T","code_information":[{"code":"6434","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.48,"setting":"both","billing_class":"facility"}]},{"description":"BETAXOL 0.25% 10ML","code_information":[{"code":"6435","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":699.8,"discounted_cash":349.9,"setting":"both","billing_class":"facility"}]},{"description":"TIMOL MAL 0.25% 10ML","code_information":[{"code":"6436","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.35,"discounted_cash":23.68,"setting":"both","billing_class":"facility"}]},{"description":"NEPRO 240ML","code_information":[{"code":"6437","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":1.93,"setting":"both","billing_class":"facility"}]},{"description":"MORPH 20MG/ML 30ML","code_information":[{"code":"6438","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.3,"discounted_cash":4.15,"setting":"both","billing_class":"facility"}]},{"description":"MNT IND ASSESS/15MN","code_information":[{"code":"644","type":"CDM"},{"code":"942","type":"RC"},{"code":"97802","type":"CPT"},{"code":"885","type":"LOCAL"}],"standard_charges":[{"gross_charge":45.04,"discounted_cash":22.52,"setting":"both","billing_class":"facility"}]},{"description":"DORZOLAMIDE 2% 10ML","code_information":[{"code":"6440","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":167.5,"discounted_cash":83.75,"setting":"both","billing_class":"facility"}]},{"description":"LET SOLN TS 5ML","code_information":[{"code":"6441","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.94,"discounted_cash":9.97,"setting":"both","billing_class":"facility"}]},{"description":"LISINOPRIL 40MG T","code_information":[{"code":"6442","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility"}]},{"description":"EPI NASAL 0.1% 30ML","code_information":[{"code":"6445","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":470.75,"discounted_cash":235.38,"setting":"both","billing_class":"facility"}]},{"description":"ORTHO KNEE COCKTAIL","code_information":[{"code":"6446","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.05,"discounted_cash":23.52,"setting":"both","billing_class":"facility"}]},{"description":"COLLAGEN HEMOSTAT","code_information":[{"code":"6447","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.6,"discounted_cash":110.8,"setting":"both","billing_class":"facility"}]},{"description":"HIV PROPHYLAX KIT 3","code_information":[{"code":"6448","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.6,"discounted_cash":187.8,"setting":"both","billing_class":"facility"}]},{"description":"BAC POLYB PWD 10GM","code_information":[{"code":"6449","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.4,"discounted_cash":17.2,"setting":"both","billing_class":"facility"}]},{"description":"MNT IND REASS/15MN","code_information":[{"code":"645","type":"CDM"},{"code":"942","type":"RC"},{"code":"97803","type":"CPT"},{"code":"885","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.68,"discounted_cash":18.34,"setting":"both","billing_class":"facility"}]},{"description":"LEVALBUTER 15GM AER","code_information":[{"code":"6450","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":153.75,"discounted_cash":76.88,"setting":"both","billing_class":"facility"}]},{"description":"SWEET EASE","code_information":[{"code":"6451","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility"}]},{"description":"RIVAROXABAN 10MG T","code_information":[{"code":"6453","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.35,"discounted_cash":16.18,"setting":"both","billing_class":"facility"}]},{"description":"ALISKIREN 150MG T","code_information":[{"code":"6454","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":6.2,"setting":"both","billing_class":"facility"}]},{"description":"DABIGATRAN 150MG C","code_information":[{"code":"6455","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.45,"discounted_cash":7.72,"setting":"both","billing_class":"facility"}]},{"description":"DABIGATRAN 75MG C","code_information":[{"code":"6456","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":7.53,"setting":"both","billing_class":"facility"}]},{"description":"DRONEDARON 400MG T","code_information":[{"code":"6457","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.8,"discounted_cash":11.9,"setting":"both","billing_class":"facility"}]},{"description":"ESTRADIOL TDP 0.075","code_information":[{"code":"6458","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.25,"discounted_cash":43.13,"setting":"both","billing_class":"facility"}]},{"description":"FEBUXOSTAT 40MG T","code_information":[{"code":"6459","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility"}]},{"description":"MNT GRP/PERSON/30MN","code_information":[{"code":"646","type":"CDM"},{"code":"942","type":"RC"},{"code":"97804","type":"CPT"},{"code":"885","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.09,"discounted_cash":12.04,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL TD 12MCG/HR","code_information":[{"code":"6460","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.65,"discounted_cash":55.83,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCORT 1% CREAM","code_information":[{"code":"6461","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.63,"setting":"both","billing_class":"facility"}]},{"description":"ART TEARS 2.5% 15ML","code_information":[{"code":"6462","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.45,"discounted_cash":29.73,"setting":"both","billing_class":"facility"}]},{"description":"MASTISOL ADH 2OZ","code_information":[{"code":"6463","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":40.95,"discounted_cash":20.48,"setting":"both","billing_class":"facility"}]},{"description":"RALTEGRAVIR 400MG TA","code_information":[{"code":"6464","type":"CDM"},{"code":"259","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.2,"discounted_cash":28.6,"setting":"both","billing_class":"facility"}]},{"description":"DESVENLAFAXINE 50MGT","code_information":[{"code":"6465","type":"CDM"},{"code":"259","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":5.6,"setting":"both","billing_class":"facility"}]},{"description":"DSG PETROLAT GZ 5X9","code_information":[{"code":"6466","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.05,"discounted_cash":3.02,"setting":"both","billing_class":"facility"}]},{"description":"DSG HYDROCOLLD 44ML","code_information":[{"code":"6467","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.15,"discounted_cash":26.07,"setting":"both","billing_class":"facility"}]},{"description":"FORMOT NEB 20MCG/2ML","code_information":[{"code":"6469","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.02,"discounted_cash":29.01,"setting":"both","billing_class":"facility"}]},{"description":"LANATHUM 500MG CT","code_information":[{"code":"6470","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.05,"discounted_cash":13.53,"setting":"both","billing_class":"facility"}]},{"description":"LIDO 3.5% OPTH GEL","code_information":[{"code":"6471","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.35,"discounted_cash":33.17,"setting":"both","billing_class":"facility"}]},{"description":"LUBIPROSTONE 24MCG C","code_information":[{"code":"6472","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.9,"discounted_cash":6.95,"setting":"both","billing_class":"facility"}]},{"description":"HEMOSTAT GELFOAM KIT","code_information":[{"code":"6473","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.65,"discounted_cash":151.82,"setting":"both","billing_class":"facility"}]},{"description":"LEVONRGSTRL 1.5MG T","code_information":[{"code":"6474","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.25,"discounted_cash":36.63,"setting":"both","billing_class":"facility"}]},{"description":"PHENOL EZ SWAB 89%","code_information":[{"code":"6475","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.9,"discounted_cash":8.45,"setting":"both","billing_class":"facility"}]},{"description":"PALIPERIDONE 3MG ERT","code_information":[{"code":"6476","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.35,"discounted_cash":42.17,"setting":"both","billing_class":"facility"}]},{"description":"ARIPIPRAZOLE 2MG T","code_information":[{"code":"6477","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.1,"discounted_cash":30.05,"setting":"both","billing_class":"facility"}]},{"description":"VENELEX OINTMENT","code_information":[{"code":"6478","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3590","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":37.25,"setting":"both","billing_class":"facility"}]},{"description":"FILGRST AAFI 300MCG","code_information":[{"code":"6479","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5110","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.46,"setting":"both","billing_class":"facility"}]},{"description":"FILGRST AAFI 480MCG","code_information":[{"code":"6480","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5110","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.46,"setting":"both","billing_class":"facility"}]},{"description":"APREPITANT 5MG(40)","code_information":[{"code":"6481","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8501","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.55,"discounted_cash":12.28,"setting":"both","billing_class":"facility"}]},{"description":"PITOCIN 30UN/500ML","code_information":[{"code":"6482","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7999","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":91.64,"discounted_cash":45.82,"setting":"both","billing_class":"facility"}]},{"description":"FLUCELVAX 0.5ML","code_information":[{"code":"6483","type":"CDM"},{"code":"636","type":"RC"},{"code":"90674","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":85.54,"discounted_cash":42.77,"setting":"both","billing_class":"facility"}]},{"description":"EPHEDRINE 50MG/10ML","code_information":[{"code":"6484","type":"CDM"},{"code":"250","type":"RC"},{"code":"90674","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.74,"discounted_cash":40.37,"setting":"both","billing_class":"facility"}]},{"description":"TRATUZUMAB-DKST 10MG","code_information":[{"code":"6485","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5114","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":169.89,"discounted_cash":84.94,"setting":"both","billing_class":"facility"}]},{"description":"TRASTUZUMB-DTTB(10MG","code_information":[{"code":"6486","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5112","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":180.31,"discounted_cash":90.16,"setting":"both","billing_class":"facility"}]},{"description":"DAPAGLIFL 10 MG TAB","code_information":[{"code":"6487","type":"CDM"},{"code":"259","type":"RC"},{"code":"Q5112","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":19.25,"setting":"both","billing_class":"facility"}]},{"description":"DEXMEDETMIDNE 1000MG","code_information":[{"code":"6488","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":285.62,"discounted_cash":142.81,"setting":"both","billing_class":"facility"}]},{"description":"POLATUZMB VED 1MG(30","code_information":[{"code":"6489","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9309","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":255.85,"discounted_cash":127.92,"setting":"both","billing_class":"facility"}]},{"description":"POLATUZ VED 1MG(140","code_information":[{"code":"6490","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9309","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":255.85,"discounted_cash":127.92,"setting":"both","billing_class":"facility"}]},{"description":"LANREOTDE 1MG(120MG)","code_information":[{"code":"6491","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1930","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":162.62,"discounted_cash":81.31,"setting":"both","billing_class":"facility"}]},{"description":"PERTUZ TRAS 1200-600","code_information":[{"code":"6492","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":148.46,"discounted_cash":74.23,"setting":"both","billing_class":"facility"}]},{"description":"PERTUZ TRAST 600-600","code_information":[{"code":"6493","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":148.46,"discounted_cash":74.23,"setting":"both","billing_class":"facility"}]},{"description":"BUTORPHAN 2MG INJ","code_information":[{"code":"6494","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0595","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":5.08,"setting":"both","billing_class":"facility"}]},{"description":"DHE MES  1MG/ML J","code_information":[{"code":"6497","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":304.37,"discounted_cash":152.19,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL 100MCG/2ML","code_information":[{"code":"6498","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.9,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX ADDL HR","code_information":[{"code":"65","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.55,"discounted_cash":27.27,"setting":"both","billing_class":"facility"}]},{"description":"KETAMINE 50/ML 10ML","code_information":[{"code":"6501","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 1% 2ML","code_information":[{"code":"6504","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.21,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 2% PER APP","code_information":[{"code":"6507","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.15,"discounted_cash":11.07,"setting":"both","billing_class":"facility"}]},{"description":"PRV MED CNSL IND 15M","code_information":[{"code":"651","type":"CDM"},{"code":"942","type":"RC"},{"code":"99401","type":"CPT"},{"code":"885","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.1,"discounted_cash":14.55,"setting":"both","billing_class":"facility"}]},{"description":"LIDO DEX  SPIN 5% 2M","code_information":[{"code":"6510","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.65,"discounted_cash":17.32,"setting":"both","billing_class":"facility"}]},{"description":"LIDOC,EPI 0.5% 50ML","code_information":[{"code":"6511","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.7,"discounted_cash":5.85,"setting":"both","billing_class":"facility"}]},{"description":"LIDOC,EPI 1% 20ML","code_information":[{"code":"6512","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.02,"setting":"both","billing_class":"facility"}]},{"description":"LIDOC,EPI 2% 20ML","code_information":[{"code":"6513","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.02,"setting":"both","billing_class":"facility"}]},{"description":"MEPERIDINE 100MG J","code_information":[{"code":"6515","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.38,"discounted_cash":3.69,"setting":"both","billing_class":"facility"}]},{"description":"MEPERIDINE 25MG J","code_information":[{"code":"6516","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.06,"discounted_cash":11.53,"setting":"both","billing_class":"facility"}]},{"description":"MEPERIDINE 50MG J","code_information":[{"code":"6517","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.88,"discounted_cash":11.94,"setting":"both","billing_class":"facility"}]},{"description":"PRV MED CNSL IND 30M","code_information":[{"code":"652","type":"CDM"},{"code":"942","type":"RC"},{"code":"99402","type":"CPT"},{"code":"885","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.57,"discounted_cash":29.79,"setting":"both","billing_class":"facility"}]},{"description":"METHOCARB 1GM/10ML","code_information":[{"code":"6520","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.49,"discounted_cash":19.25,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE 10MG J","code_information":[{"code":"6522","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.38,"discounted_cash":3.69,"setting":"both","billing_class":"facility"}]},{"description":"NALBUPHINE 10MG J","code_information":[{"code":"6525","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.09,"discounted_cash":7.04,"setting":"both","billing_class":"facility"}]},{"description":"PANCURONIUM 2MG J","code_information":[{"code":"6526","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.3,"discounted_cash":15.65,"setting":"both","billing_class":"facility"}]},{"description":"SUCC CHOL 20MG J","code_information":[{"code":"6528","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.92,"discounted_cash":3.46,"setting":"both","billing_class":"facility"}]},{"description":"PRV MED CNSL IND 45M","code_information":[{"code":"653","type":"CDM"},{"code":"942","type":"RC"},{"code":"99403","type":"CPT"},{"code":"885","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.77,"discounted_cash":44.38,"setting":"both","billing_class":"facility"}]},{"description":"BUPIV 0.5MG (0.25%)","code_information":[{"code":"6532","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.13,"setting":"both","billing_class":"facility"}]},{"description":"BUPIV 0.5MG (0.25%)","code_information":[{"code":"6533","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.1,"discounted_cash":0.05,"setting":"both","billing_class":"facility"}]},{"description":"BUPIV 0.5% 10ML","code_information":[{"code":"6535","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.1,"discounted_cash":0.05,"setting":"both","billing_class":"facility"}]},{"description":"BUPIV 0.5% 30ML","code_information":[{"code":"6536","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.03,"setting":"both","billing_class":"facility"}]},{"description":"PRV MED CNSL IND 60M","code_information":[{"code":"654","type":"CDM"},{"code":"942","type":"RC"},{"code":"99404","type":"CPT"},{"code":"885","type":"LOCAL"}],"standard_charges":[{"gross_charge":117.88,"discounted_cash":58.94,"setting":"both","billing_class":"facility"}]},{"description":"ORPHENADRINE 60MG J","code_information":[{"code":"6541","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.4,"discounted_cash":28.7,"setting":"both","billing_class":"facility"}]},{"description":"SUFENTANIL 2ML J","code_information":[{"code":"6544","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.3,"discounted_cash":15.65,"setting":"both","billing_class":"facility"}]},{"description":"ABSOLUTE ALCOHOL 1ML","code_information":[{"code":"6546","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":43.4,"discounted_cash":21.7,"setting":"both","billing_class":"facility"}]},{"description":"BUPIV EPI 0.5% 30ML","code_information":[{"code":"6547","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.55,"discounted_cash":8.78,"setting":"both","billing_class":"facility"}]},{"description":"BUPRENOR 0.3MG/ML J","code_information":[{"code":"6551","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0592","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.17,"discounted_cash":7.59,"setting":"both","billing_class":"facility"}]},{"description":"VECURONIUM 100MG J","code_information":[{"code":"6552","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0592","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":170.55,"discounted_cash":85.28,"setting":"both","billing_class":"facility"}]},{"description":"KETOROLAC 15MG J","code_information":[{"code":"6554","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.8,"discounted_cash":11.9,"setting":"both","billing_class":"facility"}]},{"description":"KETOROL 30MG/1ML SYR","code_information":[{"code":"6555","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.74,"discounted_cash":2.87,"setting":"both","billing_class":"facility"}]},{"description":"KETOROLAC 30MG J","code_information":[{"code":"6556","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.33,"discounted_cash":5.67,"setting":"both","billing_class":"facility"}]},{"description":"SUMATRIP S 6MG/0.5 J","code_information":[{"code":"6560","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":153.8,"discounted_cash":76.9,"setting":"both","billing_class":"facility"}]},{"description":"BENZTROPINE 2MG J","code_information":[{"code":"6561","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0515","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.25,"discounted_cash":48.13,"setting":"both","billing_class":"facility"}]},{"description":"CHLORPROM 50MG J","code_information":[{"code":"6565","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.45,"discounted_cash":43.73,"setting":"both","billing_class":"facility"}]},{"description":"DIAZEPAM 5MG J","code_information":[{"code":"6566","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.3,"discounted_cash":7.15,"setting":"both","billing_class":"facility"}]},{"description":"DIAZEPAM 10MG/2ML J","code_information":[{"code":"6567","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.13,"discounted_cash":21.07,"setting":"both","billing_class":"facility"}]},{"description":"DROPERIDOL 5MG/2MLJ","code_information":[{"code":"6568","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.48,"discounted_cash":6.74,"setting":"both","billing_class":"facility"}]},{"description":"HALOPERIDOL 5MG J","code_information":[{"code":"6572","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.06,"discounted_cash":11.53,"setting":"both","billing_class":"facility"}]},{"description":"HYDROXYZINE 50MG J","code_information":[{"code":"6573","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3410","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.39,"discounted_cash":17.2,"setting":"both","billing_class":"facility"}]},{"description":"LORAZEPAM 2MG J","code_information":[{"code":"6574","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.41,"discounted_cash":3.21,"setting":"both","billing_class":"facility"}]},{"description":"PHENOBARB 130MG J","code_information":[{"code":"6576","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":85.1,"discounted_cash":42.55,"setting":"both","billing_class":"facility"}]},{"description":"PHENYTOIN 100MG J","code_information":[{"code":"6578","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.18,"discounted_cash":1.59,"setting":"both","billing_class":"facility"}]},{"description":"PHENYTOIN 250MG J","code_information":[{"code":"6579","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.64,"setting":"both","billing_class":"facility"}]},{"description":"ALPROST PED 500MCG J","code_information":[{"code":"6584","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0270","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.36,"setting":"both","billing_class":"facility"}]},{"description":"FENOLDOP 10MG J","code_information":[{"code":"6585","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0270","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":697.35,"discounted_cash":348.68,"setting":"both","billing_class":"facility"}]},{"description":"AMINOPHYLLIN 250MG J","code_information":[{"code":"6586","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.48,"discounted_cash":6.74,"setting":"both","billing_class":"facility"}]},{"description":"DIGOXIN 0.5MG/2ML J","code_information":[{"code":"6590","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.63,"discounted_cash":10.81,"setting":"both","billing_class":"facility"}]},{"description":"DOBUT 250/20 20ML J","code_information":[{"code":"6591","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.22,"discounted_cash":10.61,"setting":"both","billing_class":"facility"}]},{"description":"EPHEDR 50MG J","code_information":[{"code":"6593","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.8,"discounted_cash":11.9,"setting":"both","billing_class":"facility"}]},{"description":"EPINEPH 1:1000 1ML J","code_information":[{"code":"6595","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":56.43,"discounted_cash":28.21,"setting":"both","billing_class":"facility"}]},{"description":"FUROSEM 100MG/10ML J","code_information":[{"code":"6597","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.72,"discounted_cash":1.36,"setting":"both","billing_class":"facility"}]},{"description":"FUROSEM 20/2ML J","code_information":[{"code":"6598","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.92,"discounted_cash":4.46,"setting":"both","billing_class":"facility"}]},{"description":"FUROSEM 40/4ML J","code_information":[{"code":"6599","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.59,"discounted_cash":2.8,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX SEQ 1HR","code_information":[{"code":"66","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.75,"discounted_cash":79.38,"setting":"both","billing_class":"facility"}]},{"description":"HYDRALAZINE 20MG J","code_information":[{"code":"6600","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.59,"discounted_cash":17.3,"setting":"both","billing_class":"facility"}]},{"description":"ISOPROTER 1:5000 5ML","code_information":[{"code":"6601","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":160.75,"discounted_cash":80.38,"setting":"both","billing_class":"facility"}]},{"description":"NTG IC 5MG(50MCG/10M","code_information":[{"code":"6604","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2305","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.05,"discounted_cash":4.03,"setting":"both","billing_class":"facility"}]},{"description":"NITROPRUS 50MG J","code_information":[{"code":"6605","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2305","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":676.05,"discounted_cash":338.02,"setting":"both","billing_class":"facility"}]},{"description":"NOREPINEPH 4ML J","code_information":[{"code":"6606","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2305","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.3,"discounted_cash":16.65,"setting":"both","billing_class":"facility"}]},{"description":"PHENTOL MESY 5MG J","code_information":[{"code":"6608","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2760","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1005.73,"discounted_cash":502.87,"setting":"both","billing_class":"facility"}]},{"description":"PROCAINAMIDE 1G J","code_information":[{"code":"6610","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2690","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.36,"discounted_cash":42.18,"setting":"both","billing_class":"facility"}]},{"description":"PROPRANOLOL 1MG J","code_information":[{"code":"6611","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1800","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.72,"discounted_cash":15.86,"setting":"both","billing_class":"facility"}]},{"description":"SINCALIDE 5MCG J","code_information":[{"code":"6613","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2805","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":233.55,"discounted_cash":116.78,"setting":"both","billing_class":"facility"}]},{"description":"TERBUTALINE 1MG J","code_information":[{"code":"6614","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":7.71,"setting":"both","billing_class":"facility"}]},{"description":"VERAPAMIL 5MG/2MLJ","code_information":[{"code":"6615","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.4,"discounted_cash":43.7,"setting":"both","billing_class":"facility"}]},{"description":"METOPROL 5MG/5ML J","code_information":[{"code":"6617","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"LABETAL 5MG(100MG/20","code_information":[{"code":"6620","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.36,"setting":"both","billing_class":"facility"}]},{"description":"ESMOLOL 10 MG(100MG)","code_information":[{"code":"6625","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":3.05,"setting":"both","billing_class":"facility"}]},{"description":"LABETALOL 5MG(20MG)","code_information":[{"code":"6626","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.1,"discounted_cash":4.05,"setting":"both","billing_class":"facility"}]},{"description":"DEXTROS 25% 10ML SYR","code_information":[{"code":"6627","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.3,"discounted_cash":15.65,"setting":"both","billing_class":"facility"}]},{"description":"ETHAMOL 100MG/2ML J","code_information":[{"code":"6628","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1430","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.43,"discounted_cash":493.71,"setting":"both","billing_class":"facility"}]},{"description":"DILTIAZ 125MG/25ML J","code_information":[{"code":"6630","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1430","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.6,"discounted_cash":18.8,"setting":"both","billing_class":"facility"}]},{"description":"ENALAPR 1.25MG/1ML J","code_information":[{"code":"6631","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1430","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"AMPHOTER B 50MG J","code_information":[{"code":"6634","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0285","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.7,"discounted_cash":58.35,"setting":"both","billing_class":"facility"}]},{"description":"AMPICILLIN 125MG J","code_information":[{"code":"6635","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.66,"discounted_cash":8.33,"setting":"both","billing_class":"facility"}]},{"description":"AMPICILLIN 1GM J","code_information":[{"code":"6636","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.43,"discounted_cash":5.71,"setting":"both","billing_class":"facility"}]},{"description":"AMPICILLIN 500MG J","code_information":[{"code":"6638","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.4,"discounted_cash":6.7,"setting":"both","billing_class":"facility"}]},{"description":"AMPICILLIN 250MG J","code_information":[{"code":"6639","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.92,"discounted_cash":4.46,"setting":"both","billing_class":"facility"}]},{"description":"CEFAZOLIN 1GM J","code_information":[{"code":"6640","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.18,"discounted_cash":1.59,"setting":"both","billing_class":"facility"}]},{"description":"CEFOXITIN 1GM J","code_information":[{"code":"6645","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.4,"discounted_cash":12.2,"setting":"both","billing_class":"facility"}]},{"description":"CHLORAMPHEN 1GM J","code_information":[{"code":"6648","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0720","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":119.98,"discounted_cash":59.99,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAMY 300/2ML","code_information":[{"code":"6649","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":5.1,"setting":"both","billing_class":"facility"}]},{"description":"OBESITY CONSULT 15M","code_information":[{"code":"665","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0447","type":"HCPCS"},{"code":"885","type":"LOCAL"}],"standard_charges":[{"gross_charge":119.23,"discounted_cash":59.62,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAM 300MG(600MG)","code_information":[{"code":"6650","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"DOXYCYCL 100MG J","code_information":[{"code":"6651","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.65,"discounted_cash":36.33,"setting":"both","billing_class":"facility"}]},{"description":"ERYTHR LAC 500 J","code_information":[{"code":"6653","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1364","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":229.09,"discounted_cash":114.55,"setting":"both","billing_class":"facility"}]},{"description":"GENTAM 20MG/2ML J","code_information":[{"code":"6655","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":7.53,"setting":"both","billing_class":"facility"}]},{"description":"GENTAM 80MG/2ML J","code_information":[{"code":"6657","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.3,"discounted_cash":6.15,"setting":"both","billing_class":"facility"}]},{"description":"IVIG GAMMAGARD 10%","code_information":[{"code":"6658","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":156.52,"discounted_cash":78.26,"setting":"both","billing_class":"facility"}]},{"description":"HEP B IG 5ML","code_information":[{"code":"6659","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1571","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":184.91,"discounted_cash":92.45,"setting":"both","billing_class":"facility"}]},{"description":"FOLIC AC 5MG/ML 10ML","code_information":[{"code":"6660","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1571","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"NAFCILLIN 2GM J","code_information":[{"code":"6669","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2265","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.7,"discounted_cash":35.35,"setting":"both","billing_class":"facility"}]},{"description":"PEN G K 5MU J","code_information":[{"code":"6674","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.87,"discounted_cash":2.44,"setting":"both","billing_class":"facility"}]},{"description":"RABIES IG 300/2ML J","code_information":[{"code":"6688","type":"CDM"},{"code":"636","type":"RC"},{"code":"90377","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":839.22,"discounted_cash":419.61,"setting":"both","billing_class":"facility"}]},{"description":"RABIES VAC 2.5 U J","code_information":[{"code":"6689","type":"CDM"},{"code":"250","type":"RC"},{"code":"90675","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":796.94,"discounted_cash":398.47,"setting":"both","billing_class":"facility"}]},{"description":"TET IMM GLOB 250U","code_information":[{"code":"6691","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1670","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1224.21,"discounted_cash":612.11,"setting":"both","billing_class":"facility"}]},{"description":"TOBRAMY 40MG/ML 2ML","code_information":[{"code":"6695","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.69,"discounted_cash":3.85,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 500MG J","code_information":[{"code":"6696","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.8,"discounted_cash":15.4,"setting":"both","billing_class":"facility"}]},{"description":"DIP TET PED 0.5ML J","code_information":[{"code":"6698","type":"CDM"},{"code":"250","type":"RC"},{"code":"90702","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":163.95,"discounted_cash":81.97,"setting":"both","billing_class":"facility"}]},{"description":"CEFUROXIME 750MG J","code_information":[{"code":"6699","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0697","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.53,"discounted_cash":5.76,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX CONCRNT","code_information":[{"code":"67","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":90.85,"discounted_cash":45.42,"setting":"both","billing_class":"facility"}]},{"description":"CEFUROXIME 1.5GM J","code_information":[{"code":"6700","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0697","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.22,"discounted_cash":5.61,"setting":"both","billing_class":"facility"}]},{"description":"BACITRACIN 50,000UJ","code_information":[{"code":"6702","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0697","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.6,"discounted_cash":12.3,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAM 300MG(900MG)","code_information":[{"code":"6703","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.64,"discounted_cash":2.82,"setting":"both","billing_class":"facility"}]},{"description":"HEP B VAC ADULT 1ML","code_information":[{"code":"6706","type":"CDM"},{"code":"250","type":"RC"},{"code":"90746","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":180.91,"discounted_cash":90.45,"setting":"both","billing_class":"facility"}]},{"description":"CEFTRXNE 250MG(1GM)","code_information":[{"code":"6707","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.77,"setting":"both","billing_class":"facility"}]},{"description":"CEFTRIAXONE 2GM J","code_information":[{"code":"6708","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.05,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYC 1000MG J","code_information":[{"code":"6710","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.49,"discounted_cash":15.24,"setting":"both","billing_class":"facility"}]},{"description":"CEFTAZIDIME 1GM J","code_information":[{"code":"6711","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.66,"discounted_cash":4.33,"setting":"both","billing_class":"facility"}]},{"description":"CEFTAZIDIME 2GM J","code_information":[{"code":"6712","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":4.35,"setting":"both","billing_class":"facility"}]},{"description":"HEP B VAC PED 10MCG","code_information":[{"code":"6713","type":"CDM"},{"code":"636","type":"RC"},{"code":"90744","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"CEFTRIAXONE 250MG J","code_information":[{"code":"6718","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.46,"discounted_cash":23.73,"setting":"both","billing_class":"facility"}]},{"description":"AZTREONAM 100MG(1GM)","code_information":[{"code":"6720","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":4.13,"setting":"both","billing_class":"facility"}]},{"description":"AZTREONAM 100MG(2GM)","code_information":[{"code":"6721","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":5.23,"setting":"both","billing_class":"facility"}]},{"description":"FLUCON 200MG/100 PB","code_information":[{"code":"6727","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.47,"discounted_cash":35.23,"setting":"both","billing_class":"facility"}]},{"description":"CIPROFLOX 400/200 PB","code_information":[{"code":"6728","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.04,"discounted_cash":8.02,"setting":"both","billing_class":"facility"}]},{"description":"CIPROFLOX 200/100 PB","code_information":[{"code":"6729","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.08,"discounted_cash":16.04,"setting":"both","billing_class":"facility"}]},{"description":"PIPERAC TAZ 3.375G J","code_information":[{"code":"6734","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.22,"discounted_cash":6.61,"setting":"both","billing_class":"facility"}]},{"description":"PIPERAC TAZ 2.25G  J","code_information":[{"code":"6735","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.12,"discounted_cash":6.56,"setting":"both","billing_class":"facility"}]},{"description":"DEXPANTHENOL 2ML J","code_information":[{"code":"6737","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.1,"discounted_cash":7.05,"setting":"both","billing_class":"facility"}]},{"description":"GLYCOPYR 0.1(0.4MG/2","code_information":[{"code":"6740","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.24,"discounted_cash":2.12,"setting":"both","billing_class":"facility"}]},{"description":"GLYCOP 1MG/5ML MDV J","code_information":[{"code":"6741","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":5.17,"setting":"both","billing_class":"facility"}]},{"description":"METOCLOPR 10MG/2ML J","code_information":[{"code":"6742","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.41,"discounted_cash":3.21,"setting":"both","billing_class":"facility"}]},{"description":"PROCHLORP 10/2 J","code_information":[{"code":"6744","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":28.75,"setting":"both","billing_class":"facility"}]},{"description":"TRIMETHOBENZ 200MG J","code_information":[{"code":"6745","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3250","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":118.7,"discounted_cash":59.35,"setting":"both","billing_class":"facility"}]},{"description":"FAMOTIDINE 20/2ML","code_information":[{"code":"6747","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.41,"discounted_cash":3.21,"setting":"both","billing_class":"facility"}]},{"description":"OCTREOTIDE 50MCG J","code_information":[{"code":"6748","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.95,"discounted_cash":12.97,"setting":"both","billing_class":"facility"}]},{"description":"LACOSAM 10MG/ML 20ML","code_information":[{"code":"6749","type":"CDM"},{"code":"250","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.59,"setting":"both","billing_class":"facility"}]},{"description":"CISPLATIN EA 10MG J","code_information":[{"code":"6751","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.93,"discounted_cash":13.96,"setting":"both","billing_class":"facility"}]},{"description":"CYTARABINE 100MG J","code_information":[{"code":"6752","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.02,"discounted_cash":3.51,"setting":"both","billing_class":"facility"}]},{"description":"DACARBAZINE 100MG J","code_information":[{"code":"6753","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.14,"discounted_cash":31.57,"setting":"both","billing_class":"facility"}]},{"description":"DOXORUB EA 10MG","code_information":[{"code":"6755","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.29,"discounted_cash":34.65,"setting":"both","billing_class":"facility"}]},{"description":"LEUCOVOR CAL 50MG J","code_information":[{"code":"6757","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.55,"discounted_cash":10.28,"setting":"both","billing_class":"facility"}]},{"description":"MITOMYCIN EA 5MG J","code_information":[{"code":"6761","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":908.3,"discounted_cash":454.15,"setting":"both","billing_class":"facility"}]},{"description":"MEROPENEM 100MG(500)","code_information":[{"code":"6764","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":5.36,"setting":"both","billing_class":"facility"}]},{"description":"IFOSFAMIDE 1GM J","code_information":[{"code":"6765","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":112.9,"discounted_cash":56.45,"setting":"both","billing_class":"facility"}]},{"description":"MESNA 200MG J","code_information":[{"code":"6766","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":40.8,"discounted_cash":20.4,"setting":"both","billing_class":"facility"}]},{"description":"LEUPROLIDE DEP 3.75","code_information":[{"code":"6767","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3003.51,"discounted_cash":1501.76,"setting":"both","billing_class":"facility"}]},{"description":"FLUDARABINE 50MG J","code_information":[{"code":"6768","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9185","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1674.65,"discounted_cash":837.33,"setting":"both","billing_class":"facility"}]},{"description":"PACLITAXL 1MG/.167ML","code_information":[{"code":"6769","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.72,"discounted_cash":1.36,"setting":"both","billing_class":"facility"}]},{"description":"ETOPOSIDE PER 10MG J","code_information":[{"code":"6770","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":108.45,"discounted_cash":54.23,"setting":"both","billing_class":"facility"}]},{"description":"VINBLASTINE SUL 1MG","code_information":[{"code":"6771","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9360","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.06,"discounted_cash":16.53,"setting":"both","billing_class":"facility"}]},{"description":"VINCRISTINE 1MG/1ML","code_information":[{"code":"6772","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":44.28,"discounted_cash":22.14,"setting":"both","billing_class":"facility"}]},{"description":"CARBOPLAT EA 50MG J","code_information":[{"code":"6773","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.17,"discounted_cash":32.09,"setting":"both","billing_class":"facility"}]},{"description":"MITOXANTR PER 5MG J","code_information":[{"code":"6774","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9293","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":333.33,"discounted_cash":166.66,"setting":"both","billing_class":"facility"}]},{"description":"CYCLOPHS 5MG(500/2.5","code_information":[{"code":"6775","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9073","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.86,"discounted_cash":10.43,"setting":"both","billing_class":"facility"}]},{"description":"VINORELBINE EA 10MG","code_information":[{"code":"6777","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9390","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":192.44,"discounted_cash":96.22,"setting":"both","billing_class":"facility"}]},{"description":"INTERF ALFA-2B 10MU","code_information":[{"code":"6779","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9214","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.93,"discounted_cash":35.47,"setting":"both","billing_class":"facility"}]},{"description":"DEXAMETH 4MG/1ML J","code_information":[{"code":"6782","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":1.1,"setting":"both","billing_class":"facility"}]},{"description":"DEXAMETH 20MG/5ML J","code_information":[{"code":"6783","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.54,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCOR SS 100MG J","code_information":[{"code":"6786","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.49,"discounted_cash":19.25,"setting":"both","billing_class":"facility"}]},{"description":"HYDROCOR SS 250MG J","code_information":[{"code":"6787","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.12,"discounted_cash":9.56,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPRED LA 1MG(40","code_information":[{"code":"6789","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.01,"discounted_cash":0.51,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPRED LA 1MG(80","code_information":[{"code":"6790","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.71,"discounted_cash":0.36,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPRED SS 5MG(1G","code_information":[{"code":"6791","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.49,"discounted_cash":0.25,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPRD SS 5MG(125","code_information":[{"code":"6792","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.83,"setting":"both","billing_class":"facility"}]},{"description":"TRIAMCIN  40MG/1ML J","code_information":[{"code":"6795","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.92,"discounted_cash":4.46,"setting":"both","billing_class":"facility"}]},{"description":"TRIAMCIN 200/5  5ML","code_information":[{"code":"6796","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.82,"discounted_cash":4.41,"setting":"both","billing_class":"facility"}]},{"description":"INJ IM/SQ","code_information":[{"code":"68","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility"}]},{"description":"CALCIUM CL 1G/10 VL","code_information":[{"code":"6801","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.8,"discounted_cash":28.9,"setting":"both","billing_class":"facility"}]},{"description":"CALC GLUC 10MG(100)/","code_information":[{"code":"6803","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.18,"setting":"both","billing_class":"facility"}]},{"description":"CALCITON 200U/ML 2ML","code_information":[{"code":"6804","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5759.53,"discounted_cash":2879.76,"setting":"both","billing_class":"facility"}]},{"description":"COPPER CL PER DOSE","code_information":[{"code":"6806","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.9,"discounted_cash":2.95,"setting":"both","billing_class":"facility"}]},{"description":"CYANOCOB 1000MCG J","code_information":[{"code":"6807","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":28.19,"discounted_cash":14.1,"setting":"both","billing_class":"facility"}]},{"description":"DEXTROSE 50% 50ML EM","code_information":[{"code":"6809","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.95,"discounted_cash":15.47,"setting":"both","billing_class":"facility"}]},{"description":"ESTRADIOL CYP 25/5 J","code_information":[{"code":"6811","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1000","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.64,"discounted_cash":24.32,"setting":"both","billing_class":"facility"}]},{"description":"ESTROG CONJ 25MG J","code_information":[{"code":"6813","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1410","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":532.85,"discounted_cash":266.43,"setting":"both","billing_class":"facility"}]},{"description":"GLUCAGON 1U /1MG J","code_information":[{"code":"6816","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":396.47,"discounted_cash":198.24,"setting":"both","billing_class":"facility"}]},{"description":"NURSERY LVL 1","code_information":[{"code":"682","type":"CDM"},{"code":"171","type":"RC"},{"code":"G0447","type":"HCPCS"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":750.0,"setting":"both","billing_class":"facility"}]},{"description":"LEVOTHYR 200MCG J","code_information":[{"code":"6820","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1610","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":475.8,"discounted_cash":237.9,"setting":"both","billing_class":"facility"}]},{"description":"MAG 50% 1G/2ML INJ","code_information":[{"code":"6823","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.18,"discounted_cash":1.59,"setting":"both","billing_class":"facility"}]},{"description":"METHYLERG 0.2MG INJ","code_information":[{"code":"6826","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2210","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":79.08,"discounted_cash":39.54,"setting":"both","billing_class":"facility"}]},{"description":"MVI ADULT 10ML","code_information":[{"code":"6827","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2210","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":19.25,"setting":"both","billing_class":"facility"}]},{"description":"OXYTOCIN 10U/ML 1ML","code_information":[{"code":"6829","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.41,"discounted_cash":3.21,"setting":"both","billing_class":"facility"}]},{"description":"NURSERY LVL 2","code_information":[{"code":"683","type":"CDM"},{"code":"172","type":"RC"},{"code":"G0447","type":"HCPCS"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":1750.0,"discounted_cash":875.0,"setting":"both","billing_class":"facility"}]},{"description":"POT AC 40MEQ/20ML J","code_information":[{"code":"6830","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":6.25,"setting":"both","billing_class":"facility"}]},{"description":"POT CL 20MEQ/10ML J","code_information":[{"code":"6834","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.59,"setting":"both","billing_class":"facility"}]},{"description":"POT PO4 22MEQ/5ML J","code_information":[{"code":"6835","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.75,"discounted_cash":27.88,"setting":"both","billing_class":"facility"}]},{"description":"SOD BIC 8.4% 50ML EM","code_information":[{"code":"6837","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":39.55,"discounted_cash":19.77,"setting":"both","billing_class":"facility"}]},{"description":"TESTOST CYP 200MG J","code_information":[{"code":"6841","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.15,"discounted_cash":32.08,"setting":"both","billing_class":"facility"}]},{"description":"THIAMINE 100MG INJ","code_information":[{"code":"6843","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":39.72,"discounted_cash":19.86,"setting":"both","billing_class":"facility"}]},{"description":"TPN ELECTR 20ML INJ","code_information":[{"code":"6844","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.8,"discounted_cash":11.9,"setting":"both","billing_class":"facility"}]},{"description":"TRACE METALS 1ML J","code_information":[{"code":"6848","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":39.65,"discounted_cash":19.82,"setting":"both","billing_class":"facility"}]},{"description":"DESMOPR 4MCG 1ML J","code_information":[{"code":"6851","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.14,"discounted_cash":30.57,"setting":"both","billing_class":"facility"}]},{"description":"GOSERELIN 10.8 MG","code_information":[{"code":"6853","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9202","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2483.32,"discounted_cash":1241.66,"setting":"both","billing_class":"facility"}]},{"description":"CALCITRIOL 1MCG J","code_information":[{"code":"6854","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0636","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.02,"discounted_cash":1.51,"setting":"both","billing_class":"facility"}]},{"description":"GOSEREL AC 3.6MG INJ","code_information":[{"code":"6856","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9202","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3913.04,"discounted_cash":1956.52,"setting":"both","billing_class":"facility"}]},{"description":"PAMIDRONATE 30MG J","code_information":[{"code":"6858","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.38,"discounted_cash":41.69,"setting":"both","billing_class":"facility"}]},{"description":"CIRCUMCISION W/DEV","code_information":[{"code":"686","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":2636.11,"discounted_cash":1318.06,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN INJ 5,000 UN","code_information":[{"code":"6862","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.33,"discounted_cash":1.67,"setting":"both","billing_class":"facility"}]},{"description":"HEP FLUSH 5ML SYR","code_information":[{"code":"6863","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.64,"setting":"both","billing_class":"facility"}]},{"description":"PHYTONADIONE 10MG J","code_information":[{"code":"6864","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.91,"discounted_cash":7.46,"setting":"both","billing_class":"facility"}]},{"description":"PHYTONADIONE 1MG J","code_information":[{"code":"6865","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.86,"discounted_cash":31.93,"setting":"both","billing_class":"facility"}]},{"description":"PROTAMINE 50MG J","code_information":[{"code":"6866","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.28,"discounted_cash":4.64,"setting":"both","billing_class":"facility"}]},{"description":"MEROPENEM 1GM INJ","code_information":[{"code":"6868","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.92,"discounted_cash":4.46,"setting":"both","billing_class":"facility"}]},{"description":"INCISION TONGUE FOLD","code_information":[{"code":"687","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":3441.82,"discounted_cash":1720.91,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN BL 10000/10","code_information":[{"code":"6870","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3365","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"ENOXAPARIN 30MG J","code_information":[{"code":"6876","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.27,"discounted_cash":12.63,"setting":"both","billing_class":"facility"}]},{"description":"ATROP EMS 1MG/10ML","code_information":[{"code":"6877","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility"}]},{"description":"ATROPINE INJ 0.4MG","code_information":[{"code":"6878","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":13.75,"setting":"both","billing_class":"facility"}]},{"description":"ATROPINE INJ 1MG/ML","code_information":[{"code":"6879","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":43.85,"discounted_cash":21.93,"setting":"both","billing_class":"facility"}]},{"description":"CANDIDA SK TS 0.1ML","code_information":[{"code":"6881","type":"CDM"},{"code":"250","type":"RC"},{"code":"86485","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.41,"discounted_cash":3.21,"setting":"both","billing_class":"facility"}]},{"description":"DEFEROXAMINE 500MG/M","code_information":[{"code":"6883","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.88,"discounted_cash":17.94,"setting":"both","billing_class":"facility"}]},{"description":"DIPHENHYDR 50MG INJ","code_information":[{"code":"6884","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.41,"discounted_cash":3.21,"setting":"both","billing_class":"facility"}]},{"description":"HYALUR 200UNIT/ML J","code_information":[{"code":"6887","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3471","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.54,"setting":"both","billing_class":"facility"}]},{"description":"INDIGO CAR 5ML INJ","code_information":[{"code":"6888","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3471","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":387.45,"discounted_cash":193.72,"setting":"both","billing_class":"facility"}]},{"description":"METHYL BLUE 1% 10ML","code_information":[{"code":"6889","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3471","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":422.1,"discounted_cash":211.05,"setting":"both","billing_class":"facility"}]},{"description":"NURSERY BOARDER BABY","code_information":[{"code":"689","type":"CDM"},{"code":"179","type":"RC"},{"code":"54160","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":1850.0,"discounted_cash":925.0,"setting":"both","billing_class":"facility"}]},{"description":"NALOXONE 0.4MG/ML 1M","code_information":[{"code":"6891","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.4,"discounted_cash":30.7,"setting":"both","billing_class":"facility"}]},{"description":"PANTOPRAZOLE 40MG","code_information":[{"code":"6892","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":5.29,"setting":"both","billing_class":"facility"}]},{"description":"NEOSTIG 1MG/ML 5ML J","code_information":[{"code":"6893","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":40.39,"discounted_cash":20.2,"setting":"both","billing_class":"facility"}]},{"description":"PHENYLEPHRI 1% 20MCG","code_information":[{"code":"6894","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"PHYSOSTIG 1MG/ML 2ML","code_information":[{"code":"6895","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":235.35,"discounted_cash":117.67,"setting":"both","billing_class":"facility"}]},{"description":"PROMETH 25MG INJ","code_information":[{"code":"6896","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.87,"discounted_cash":3.44,"setting":"both","billing_class":"facility"}]},{"description":"PYRIDOSTIG 10MG/2ML","code_information":[{"code":"6898","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.4,"discounted_cash":48.2,"setting":"both","billing_class":"facility"}]},{"description":"SOD AC 40MEQ/20ML J","code_information":[{"code":"6899","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":5.92,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP SGL/INT SUBS","code_information":[{"code":"69","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":266.65,"discounted_cash":133.32,"setting":"both","billing_class":"facility"}]},{"description":"REMOVAL EXTRA DIGIT","code_information":[{"code":"690","type":"CDM"},{"code":"360","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":1813.13,"discounted_cash":906.57,"setting":"both","billing_class":"facility"}]},{"description":"MANNITOL 25% 12.5G J","code_information":[{"code":"6901","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2150","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.51,"discounted_cash":4.25,"setting":"both","billing_class":"facility"}]},{"description":"ACETAZOL 500MG INJ","code_information":[{"code":"6904","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.6,"discounted_cash":62.3,"setting":"both","billing_class":"facility"}]},{"description":"CARBOPROST 250MCG J","code_information":[{"code":"6906","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":798.75,"discounted_cash":399.38,"setting":"both","billing_class":"facility"}]},{"description":"TUBERCUL ST 5TU/0.1M","code_information":[{"code":"6907","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.3,"discounted_cash":15.65,"setting":"both","billing_class":"facility"}]},{"description":"IRINOTECAN  EA 20MG","code_information":[{"code":"6909","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.55,"discounted_cash":30.77,"setting":"both","billing_class":"facility"}]},{"description":"GEMCITABINE 200MG J","code_information":[{"code":"6910","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":97.02,"discounted_cash":48.51,"setting":"both","billing_class":"facility"}]},{"description":"DOCETAXEL 20MG/1ML J","code_information":[{"code":"6911","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.95,"discounted_cash":62.48,"setting":"both","billing_class":"facility"}]},{"description":"FOSPHEN  50MG PE INJ","code_information":[{"code":"6913","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.33,"discounted_cash":4.67,"setting":"both","billing_class":"facility"}]},{"description":"INSULIN LIS 75/25 1M","code_information":[{"code":"6915","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.17,"setting":"both","billing_class":"facility"}]},{"description":"TOPOTECAN 0.1MG INJ","code_information":[{"code":"6916","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.4,"discounted_cash":28.7,"setting":"both","billing_class":"facility"}]},{"description":"IBUTILIDE 1MG/10ML J","code_information":[{"code":"6925","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1742","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1044.63,"discounted_cash":522.32,"setting":"both","billing_class":"facility"}]},{"description":"SARGRAMOS EA 50MCG","code_information":[{"code":"6928","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2820","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":121.05,"discounted_cash":60.52,"setting":"both","billing_class":"facility"}]},{"description":"NB HEARING SCRN ABR","code_information":[{"code":"693","type":"CDM"},{"code":"470","type":"RC"},{"code":"92650","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":250.38,"discounted_cash":125.19,"setting":"both","billing_class":"facility"}]},{"description":"CEFEPIME 1000MG INJ","code_information":[{"code":"6930","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.53,"discounted_cash":5.76,"setting":"both","billing_class":"facility"}]},{"description":"AMPHO B LIPID 50MG J","code_information":[{"code":"6932","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0289","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":114.19,"discounted_cash":57.09,"setting":"both","billing_class":"facility"}]},{"description":"ONDANSETRON  1MG","code_information":[{"code":"6939","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.77,"setting":"both","billing_class":"facility"}]},{"description":"NURSERY LVL3 SCKBABY","code_information":[{"code":"694","type":"CDM"},{"code":"173","type":"RC"},{"code":"92650","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":2600.0,"discounted_cash":1300.0,"setting":"both","billing_class":"facility"}]},{"description":"AZITHROMYCIN 500MG J","code_information":[{"code":"6941","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.06,"discounted_cash":11.53,"setting":"both","billing_class":"facility"}]},{"description":"PRALIDOXIME 1G INJ","code_information":[{"code":"6942","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2730","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":200.18,"discounted_cash":100.09,"setting":"both","billing_class":"facility"}]},{"description":"TRASTAZUM EA 10MG J","code_information":[{"code":"6944","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9355","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.58,"discounted_cash":112.29,"setting":"both","billing_class":"facility"}]},{"description":"CHLOROTHIAZ 500MG J","code_information":[{"code":"6947","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1205","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1197.97,"discounted_cash":598.99,"setting":"both","billing_class":"facility"}]},{"description":"NB UMB VEIN/ART CATH","code_information":[{"code":"695","type":"CDM"},{"code":"361","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":620.42,"discounted_cash":310.21,"setting":"both","billing_class":"facility"}]},{"description":"NICARDPNE 0.1(25/10)","code_information":[{"code":"6950","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.42,"discounted_cash":0.21,"setting":"both","billing_class":"facility"}]},{"description":"BUPIV/DX 0.5MG(0.75)","code_information":[{"code":"6951","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.31,"discounted_cash":0.16,"setting":"both","billing_class":"facility"}]},{"description":"ENOXAPARIN 40MG J","code_information":[{"code":"6952","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.63,"discounted_cash":12.81,"setting":"both","billing_class":"facility"}]},{"description":"ENOXAPARIN 80MG J","code_information":[{"code":"6953","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.52,"discounted_cash":12.76,"setting":"both","billing_class":"facility"}]},{"description":"MIDAZOLAM 10MG/2ML J","code_information":[{"code":"6955","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.89,"discounted_cash":2.94,"setting":"both","billing_class":"facility"}]},{"description":"TENECTEPLASE 1MG J","code_information":[{"code":"6958","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3101","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":270.81,"discounted_cash":135.41,"setting":"both","billing_class":"facility"}]},{"description":"DANTROLENE 20MG J","code_information":[{"code":"6959","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3101","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":199.7,"discounted_cash":99.85,"setting":"both","billing_class":"facility"}]},{"description":"IMMUN ADMIN 1 VACC","code_information":[{"code":"696","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":99.43,"discounted_cash":49.72,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE PF/10MG INJ","code_information":[{"code":"6962","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.76,"discounted_cash":28.88,"setting":"both","billing_class":"facility"}]},{"description":"BOT TOX TYPE A/UN IJ","code_information":[{"code":"6963","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0585","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.84,"discounted_cash":6.92,"setting":"both","billing_class":"facility"}]},{"description":"ALTEPLASE PER 1MG","code_information":[{"code":"6965","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":206.64,"discounted_cash":103.32,"setting":"both","billing_class":"facility"}]},{"description":"RETEPLASE PER 18.1MG","code_information":[{"code":"6966","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2993","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5467.66,"discounted_cash":2733.83,"setting":"both","billing_class":"facility"}]},{"description":"AMIODARONE 30MG J","code_information":[{"code":"6967","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":1.41,"setting":"both","billing_class":"facility"}]},{"description":"IMMUN ADMIN ADD VACC","code_information":[{"code":"697","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.35,"discounted_cash":23.18,"setting":"both","billing_class":"facility"}]},{"description":"POLIDOC 1% 20MG/2ML","code_information":[{"code":"6976","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.85,"discounted_cash":39.42,"setting":"both","billing_class":"facility"}]},{"description":"PHENOL/SALINE 30ML V","code_information":[{"code":"6977","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":91.4,"discounted_cash":45.7,"setting":"both","billing_class":"facility"}]},{"description":"LEVOFLOX 250/50ML PB","code_information":[{"code":"6978","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.3,"discounted_cash":15.65,"setting":"both","billing_class":"facility"}]},{"description":"OXYGEN PER DAY","code_information":[{"code":"698","type":"CDM"},{"code":"270","type":"RC"},{"code":"90472","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":808.8,"discounted_cash":404.4,"setting":"both","billing_class":"facility"}]},{"description":"LIDO 1% MPF 5ML AMP","code_information":[{"code":"6989","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.09,"setting":"both","billing_class":"facility"}]},{"description":"ADMIN HEB B VACCINE","code_information":[{"code":"699","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0010","type":"HCPCS"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.92,"discounted_cash":88.46,"setting":"both","billing_class":"facility"}]},{"description":"INS LANTUS 100U/ML","code_information":[{"code":"6991","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":1.55,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE 2MG/ML","code_information":[{"code":"6992","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.33,"discounted_cash":3.67,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP ADD/SEQ SUBS","code_information":[{"code":"70","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.5,"discounted_cash":75.75,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM BICARB 4.2% J","code_information":[{"code":"7006","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":40.7,"discounted_cash":20.35,"setting":"both","billing_class":"facility"}]},{"description":"HEEL STICK","code_information":[{"code":"701","type":"CDM"},{"code":"300","type":"RC"},{"code":"36416","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.45,"discounted_cash":9.72,"setting":"both","billing_class":"facility"}]},{"description":"SOD BICARB 50 MEQ","code_information":[{"code":"7010","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":18.13,"setting":"both","billing_class":"facility"}]},{"description":"VENIPUNCTURE","code_information":[{"code":"702","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.65,"discounted_cash":15.32,"setting":"both","billing_class":"facility"}]},{"description":"FLUMAZ 0.5MG/5ML J","code_information":[{"code":"7020","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.2,"discounted_cash":13.1,"setting":"both","billing_class":"facility"}]},{"description":"RIFAMPIN 600MG J","code_information":[{"code":"7023","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":344.9,"discounted_cash":172.45,"setting":"both","billing_class":"facility"}]},{"description":"WATER STR 50ML J","code_information":[{"code":"7025","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.2,"discounted_cash":4.1,"setting":"both","billing_class":"facility"}]},{"description":"WATER BACT 30ML J","code_information":[{"code":"7026","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"ALBUMIN 5% 250ML","code_information":[{"code":"7027","type":"CDM"},{"code":"250","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.87,"discounted_cash":103.94,"setting":"both","billing_class":"facility"}]},{"description":"TRANSCUT BILIRUBIN","code_information":[{"code":"703","type":"CDM"},{"code":"300","type":"RC"},{"code":"88720","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.7,"discounted_cash":12.85,"setting":"both","billing_class":"facility"}]},{"description":"AMPICILLIN 2GM J","code_information":[{"code":"7032","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":5.3,"setting":"both","billing_class":"facility"}]},{"description":"ATROPINE 0.1MG/ML J","code_information":[{"code":"7035","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.15,"discounted_cash":18.07,"setting":"both","billing_class":"facility"}]},{"description":"METABOLIC SCRN (PKU)","code_information":[{"code":"704","type":"CDM"},{"code":"300","type":"RC"},{"code":"84030","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":112.8,"discounted_cash":56.4,"setting":"both","billing_class":"facility"}]},{"description":"CARSEAT/BED TEST 60","code_information":[{"code":"705","type":"CDM"},{"code":"460","type":"RC"},{"code":"94780","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":141.81,"discounted_cash":70.91,"setting":"both","billing_class":"facility"}]},{"description":"CORTROSYN 0.25MG J","code_information":[{"code":"7054","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0834","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":246.41,"discounted_cash":123.2,"setting":"both","billing_class":"facility"}]},{"description":"CARSEAT/BED TST ADDL","code_information":[{"code":"706","type":"CDM"},{"code":"460","type":"RC"},{"code":"94781","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.94,"discounted_cash":112.47,"setting":"both","billing_class":"facility"}]},{"description":"ENOXAPARIN 100MG J","code_information":[{"code":"7061","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.86,"discounted_cash":10.43,"setting":"both","billing_class":"facility"}]},{"description":"ETHYL ALC 98%AMP J","code_information":[{"code":"7063","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":291.75,"discounted_cash":145.88,"setting":"both","billing_class":"facility"}]},{"description":"ETOMIDATE 20MG/ML","code_information":[{"code":"7064","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.85,"discounted_cash":10.43,"setting":"both","billing_class":"facility"}]},{"description":"FLUORESC 10% OP J","code_information":[{"code":"7067","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":140.2,"discounted_cash":70.1,"setting":"both","billing_class":"facility"}]},{"description":"FLUOROURACIL 500MG J","code_information":[{"code":"7068","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.5,"discounted_cash":51.25,"setting":"both","billing_class":"facility"}]},{"description":"HEP FLUSH 5ML VIAL","code_information":[{"code":"7072","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.34,"setting":"both","billing_class":"facility"}]},{"description":"HEP SOD 10000U J","code_information":[{"code":"7073","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.54,"setting":"both","billing_class":"facility"}]},{"description":"HEP SOD 1000U J","code_information":[{"code":"7074","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.29,"discounted_cash":13.14,"setting":"both","billing_class":"facility"}]},{"description":"INSULIN LIS 100U J","code_information":[{"code":"7075","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.95,"discounted_cash":4.97,"setting":"both","billing_class":"facility"}]},{"description":"INFLIXIMAB 10MG/ML J","code_information":[{"code":"7077","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1745","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":269.78,"discounted_cash":134.89,"setting":"both","billing_class":"facility"}]},{"description":"INSULIN NPH 70/30 J","code_information":[{"code":"7079","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1745","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":1.65,"setting":"both","billing_class":"facility"}]},{"description":"INSULIN REG 100U J","code_information":[{"code":"7080","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1745","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"ISOSULFAN BL 1% ML J","code_information":[{"code":"7081","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1745","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":460.05,"discounted_cash":230.03,"setting":"both","billing_class":"facility"}]},{"description":"KETAMINEHCL 100MG MD","code_information":[{"code":"7086","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1745","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":15.5,"setting":"both","billing_class":"facility"}]},{"description":"LEUCOVORIN 50MG J","code_information":[{"code":"7088","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.86,"discounted_cash":10.43,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 1% 10ML J","code_information":[{"code":"7090","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility"}]},{"description":"ADMIN INFLUENZA VACC","code_information":[{"code":"71","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":66.65,"discounted_cash":33.33,"setting":"both","billing_class":"facility"}]},{"description":"REHAB PRIVATE","code_information":[{"code":"710","type":"CDM"},{"code":"118","type":"RC"},{"code":"99211","type":"CPT"},{"code":"370","type":"LOCAL"}],"standard_charges":[{"gross_charge":1143.5,"discounted_cash":571.75,"setting":"both","billing_class":"facility"}]},{"description":"MIDAZOL 5MG/ML 1ML J","code_information":[{"code":"7103","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.64,"setting":"both","billing_class":"facility"}]},{"description":"MILRINONE 1MG/ML J","code_information":[{"code":"7104","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":5.41,"setting":"both","billing_class":"facility"}]},{"description":"MILRINONE 200MCG/MLJ","code_information":[{"code":"7105","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.56,"discounted_cash":7.28,"setting":"both","billing_class":"facility"}]},{"description":"VALPR NA 500MG/5ML J","code_information":[{"code":"7112","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.15,"discounted_cash":47.58,"setting":"both","billing_class":"facility"}]},{"description":"OPRELVEKIN 5MG J","code_information":[{"code":"7117","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2355","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1018.29,"discounted_cash":509.14,"setting":"both","billing_class":"facility"}]},{"description":"PIPERAC/TAZ 4.5GM J","code_information":[{"code":"7125","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.12,"discounted_cash":6.56,"setting":"both","billing_class":"facility"}]},{"description":"TOBRA/SO4 40MG J","code_information":[{"code":"7126","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"SOD PHOS 3MM INJ","code_information":[{"code":"7147","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":56.05,"discounted_cash":28.02,"setting":"both","billing_class":"facility"}]},{"description":"STERILE WATER 10 ML","code_information":[{"code":"7149","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"VECURONIUM 10MG/10ML","code_information":[{"code":"7159","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.05,"discounted_cash":13.53,"setting":"both","billing_class":"facility"}]},{"description":"CALCIUM CHL 10% J","code_information":[{"code":"7169","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.15,"discounted_cash":16.07,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 2% 20ML J","code_information":[{"code":"7173","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":3.42,"setting":"both","billing_class":"facility"}]},{"description":"IRON DEXTRAN 50MG J","code_information":[{"code":"7176","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1750","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.32,"discounted_cash":51.66,"setting":"both","billing_class":"facility"}]},{"description":"PROPOFOL 10MG/ML 50M","code_information":[{"code":"7178","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.18,"setting":"both","billing_class":"facility"}]},{"description":"FILGRASTIM 300MCG/ML","code_information":[{"code":"7179","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.87,"discounted_cash":3.44,"setting":"both","billing_class":"facility"}]},{"description":"LIDO 1%/EPI 50CC","code_information":[{"code":"7181","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":6.2,"setting":"both","billing_class":"facility"}]},{"description":"EPTIFIBATE 75MG/100","code_information":[{"code":"7183","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":97.07,"discounted_cash":48.53,"setting":"both","billing_class":"facility"}]},{"description":"BUPIV .5% 50ML J","code_information":[{"code":"7185","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.27,"setting":"both","billing_class":"facility"}]},{"description":"MORRHUATE NA 50MG/ML","code_information":[{"code":"7186","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":220.85,"discounted_cash":110.42,"setting":"both","billing_class":"facility"}]},{"description":"MMR INJ","code_information":[{"code":"7193","type":"CDM"},{"code":"250","type":"RC"},{"code":"90707","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.45,"discounted_cash":109.72,"setting":"both","billing_class":"facility"}]},{"description":"LIDO/EPI 2% MDV 50ML","code_information":[{"code":"7198","type":"CDM"},{"code":"250","type":"RC"},{"code":"90707","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":7.25,"setting":"both","billing_class":"facility"}]},{"description":"ADMIN PNEUMO VACC","code_information":[{"code":"72","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":35.15,"setting":"both","billing_class":"facility"}]},{"description":"POLYMIX B 500000U V","code_information":[{"code":"7200","type":"CDM"},{"code":"250","type":"RC"},{"code":"90707","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.3,"discounted_cash":20.65,"setting":"both","billing_class":"facility"}]},{"description":"DEXAMETH 10MG/ML J","code_information":[{"code":"7201","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.05,"setting":"both","billing_class":"facility"}]},{"description":"LEUCOVORIN 100MG J","code_information":[{"code":"7204","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.88,"discounted_cash":16.94,"setting":"both","billing_class":"facility"}]},{"description":"FILGRASTIM 480MCG","code_information":[{"code":"7214","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.82,"discounted_cash":3.41,"setting":"both","billing_class":"facility"}]},{"description":"LABETALOL 5MG(10MG)","code_information":[{"code":"7217","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1921","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":5.36,"setting":"both","billing_class":"facility"}]},{"description":"METHOTREXATE 50MG","code_information":[{"code":"7220","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.57,"discounted_cash":7.29,"setting":"both","billing_class":"facility"}]},{"description":"MIDAZOLAM 1MG/ML 2ML","code_information":[{"code":"7222","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.18,"discounted_cash":1.59,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE 4MG INJ","code_information":[{"code":"7223","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.84,"discounted_cash":3.92,"setting":"both","billing_class":"facility"}]},{"description":"NTG 50MG/10ML J","code_information":[{"code":"7224","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":51.15,"discounted_cash":25.57,"setting":"both","billing_class":"facility"}]},{"description":"POT PH 4.4MEQ/15ML J","code_information":[{"code":"7225","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.3,"discounted_cash":15.65,"setting":"both","billing_class":"facility"}]},{"description":"PROCAIN 1000MG/2ML J","code_information":[{"code":"7226","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.6,"discounted_cash":53.8,"setting":"both","billing_class":"facility"}]},{"description":"SOD CHL 23.4% 30ML J","code_information":[{"code":"7229","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.9,"discounted_cash":8.45,"setting":"both","billing_class":"facility"}]},{"description":"FE SUL 220MG/5ML","code_information":[{"code":"7233","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.43,"setting":"both","billing_class":"facility"}]},{"description":"PAPAVERINE 30MG/1M","code_information":[{"code":"7236","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.38,"discounted_cash":3.69,"setting":"both","billing_class":"facility"}]},{"description":"PROPOFOL 10MG/ML 100","code_information":[{"code":"7237","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.18,"setting":"both","billing_class":"facility"}]},{"description":"AMIFOST 500MG VIAL","code_information":[{"code":"7239","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0207","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2578.03,"discounted_cash":1289.02,"setting":"both","billing_class":"facility"}]},{"description":"LEVOFLOX 250MG(500MG","code_information":[{"code":"7243","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.04,"discounted_cash":8.02,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 4% MPF 5ML","code_information":[{"code":"7249","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.05,"setting":"both","billing_class":"facility"}]},{"description":"LORAZEPAM 2MG/ML 10M","code_information":[{"code":"7250","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.38,"discounted_cash":1.69,"setting":"both","billing_class":"facility"}]},{"description":"MIDAZ 5MG/ML 5ML J","code_information":[{"code":"7251","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.46,"setting":"both","billing_class":"facility"}]},{"description":"LEVOFLOX 750MG INJ","code_information":[{"code":"7253","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0850","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":5.22,"setting":"both","billing_class":"facility"}]},{"description":"LEUPROLIDE 7.5MG","code_information":[{"code":"7254","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":966.71,"discounted_cash":483.36,"setting":"both","billing_class":"facility"}]},{"description":"BUPIV/EPI 0.25% 10ML","code_information":[{"code":"7260","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":6.88,"setting":"both","billing_class":"facility"}]},{"description":"BUPIV/EPI 0.25% 30ML","code_information":[{"code":"7261","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":5.47,"setting":"both","billing_class":"facility"}]},{"description":"BUPIV/EPI 0.5% 10ML","code_information":[{"code":"7262","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.7,"discounted_cash":7.35,"setting":"both","billing_class":"facility"}]},{"description":"BUPIV 0.5MG (0.75%)","code_information":[{"code":"7263","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.1,"discounted_cash":0.05,"setting":"both","billing_class":"facility"}]},{"description":"BUMET 0.5(.25MG/4ML)","code_information":[{"code":"7266","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.13,"discounted_cash":2.56,"setting":"both","billing_class":"facility"}]},{"description":"INS HUM/NOV R SS/UNT","code_information":[{"code":"7268","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":1.55,"setting":"both","billing_class":"facility"}]},{"description":"INS LISPRO SS/UNIT","code_information":[{"code":"7269","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.48,"setting":"both","billing_class":"facility"}]},{"description":"MENING POLY/GO A VAC","code_information":[{"code":"7270","type":"CDM"},{"code":"250","type":"RC"},{"code":"90734","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":284.23,"discounted_cash":142.12,"setting":"both","billing_class":"facility"}]},{"description":"SOD CL .9% 10ML J","code_information":[{"code":"7271","type":"CDM"},{"code":"250","type":"RC"},{"code":"90734","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"FOSPHEN 500MG PE J","code_information":[{"code":"7274","type":"CDM"},{"code":"250","type":"RC"},{"code":"90734","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.8,"discounted_cash":26.9,"setting":"both","billing_class":"facility"}]},{"description":"INDOCYAN GREEN 25MG","code_information":[{"code":"7275","type":"CDM"},{"code":"250","type":"RC"},{"code":"90734","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.6,"discounted_cash":128.3,"setting":"both","billing_class":"facility"}]},{"description":"ROCURON 10MG/ML 5ML","code_information":[{"code":"7276","type":"CDM"},{"code":"250","type":"RC"},{"code":"90734","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.3,"discounted_cash":30.65,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL 2500 MCG/50","code_information":[{"code":"7277","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.33,"discounted_cash":1.67,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL 250MCG/5MLJ","code_information":[{"code":"7278","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.73,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 2% PF 5ML","code_information":[{"code":"7279","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.8,"discounted_cash":4.9,"setting":"both","billing_class":"facility"}]},{"description":"ALTEPLASE 2MG J","code_information":[{"code":"7284","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":598.86,"discounted_cash":299.43,"setting":"both","billing_class":"facility"}]},{"description":"TORASEMIDE 10MG/ML J","code_information":[{"code":"7285","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3265","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.61,"discounted_cash":4.3,"setting":"both","billing_class":"facility"}]},{"description":"FONDAPAR 2.5MG/0.5ML","code_information":[{"code":"7286","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":14.5,"setting":"both","billing_class":"facility"}]},{"description":"DOCETAXEL 1 MG J","code_information":[{"code":"7288","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.61,"discounted_cash":23.8,"setting":"both","billing_class":"facility"}]},{"description":"ZOLEDRONIC ACID 1MG","code_information":[{"code":"7293","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1075.69,"discounted_cash":537.85,"setting":"both","billing_class":"facility"}]},{"description":"RITUXIMAB 10MG J","code_information":[{"code":"7294","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.76,"discounted_cash":174.38,"setting":"both","billing_class":"facility"}]},{"description":"RHOPHYLAC INJ IM","code_information":[{"code":"7297","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2791","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":244.31,"discounted_cash":122.16,"setting":"both","billing_class":"facility"}]},{"description":"INJ IVP SAME SUBS","code_information":[{"code":"73","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":175.75,"discounted_cash":87.88,"setting":"both","billing_class":"facility"}]},{"description":"LEUPROLIDE 22.5MG J","code_information":[{"code":"7302","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1737.17,"discounted_cash":868.59,"setting":"both","billing_class":"facility"}]},{"description":"SOD BICARB 8.4% 10ML","code_information":[{"code":"7303","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.55,"discounted_cash":26.27,"setting":"both","billing_class":"facility"}]},{"description":"BICILLIN LA 1200000","code_information":[{"code":"7306","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.24,"discounted_cash":15.12,"setting":"both","billing_class":"facility"}]},{"description":"EPI 1:1000 30ML VIAL","code_information":[{"code":"7308","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":177.5,"discounted_cash":88.75,"setting":"both","billing_class":"facility"}]},{"description":"HEP B VACC 5MCG","code_information":[{"code":"7309","type":"CDM"},{"code":"250","type":"RC"},{"code":"90744","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":74.72,"discounted_cash":37.36,"setting":"both","billing_class":"facility"}]},{"description":"HIB VACC","code_information":[{"code":"7312","type":"CDM"},{"code":"250","type":"RC"},{"code":"90648","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.83,"discounted_cash":31.41,"setting":"both","billing_class":"facility"}]},{"description":"MEDROXYPRO 150MG/MLJ","code_information":[{"code":"7323","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.8,"setting":"both","billing_class":"facility"}]},{"description":"CEFTAZ 500MG VIAL J","code_information":[{"code":"7324","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.68,"discounted_cash":12.84,"setting":"both","billing_class":"facility"}]},{"description":"LIDO 2% ABBOJECT 5ML","code_information":[{"code":"7325","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.11,"setting":"both","billing_class":"facility"}]},{"description":"MIDAZOL 5MG/ML 10MLJ","code_information":[{"code":"7329","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.25,"setting":"both","billing_class":"facility"}]},{"description":"OCTREOTIDE .2MG 5ML","code_information":[{"code":"7331","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.74,"discounted_cash":4.87,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE 30MG/30ML J","code_information":[{"code":"7332","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":7.53,"setting":"both","billing_class":"facility"}]},{"description":"MEPER 300MG/30ML J","code_information":[{"code":"7333","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.33,"discounted_cash":5.67,"setting":"both","billing_class":"facility"}]},{"description":"HYDROMOR 10MG/ML 1ML","code_information":[{"code":"7340","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.05,"setting":"both","billing_class":"facility"}]},{"description":"ZINC SULF 1MG/ML 10M","code_information":[{"code":"7343","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.1,"discounted_cash":40.05,"setting":"both","billing_class":"facility"}]},{"description":"BUMET 0.5(.25MG/10ML","code_information":[{"code":"7344","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":1.11,"setting":"both","billing_class":"facility"}]},{"description":"EPTIFIB 2MG/ML 10ML","code_information":[{"code":"7345","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":100.4,"discounted_cash":50.2,"setting":"both","billing_class":"facility"}]},{"description":"VASOPRESSIN 1U (20U)","code_information":[{"code":"7349","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.45,"discounted_cash":7.22,"setting":"both","billing_class":"facility"}]},{"description":"DILTIAZEM 25MG/5ML J","code_information":[{"code":"7351","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":1.07,"setting":"both","billing_class":"facility"}]},{"description":"INS U-100 NPH","code_information":[{"code":"7355","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":1.65,"setting":"both","billing_class":"facility"}]},{"description":"EPIRUBICIN 2MG J","code_information":[{"code":"7358","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9178","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.64,"discounted_cash":2.82,"setting":"both","billing_class":"facility"}]},{"description":"PNEUMO 23 VAC ADLT","code_information":[{"code":"7363","type":"CDM"},{"code":"250","type":"RC"},{"code":"90732","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.14,"discounted_cash":113.57,"setting":"both","billing_class":"facility"}]},{"description":"ENOXAPARIN 120MG J","code_information":[{"code":"7365","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.17,"discounted_cash":9.59,"setting":"both","billing_class":"facility"}]},{"description":"ENOXAPARIN 150MG J","code_information":[{"code":"7366","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":3.08,"setting":"both","billing_class":"facility"}]},{"description":"CEFEPIME 2GM VL INJ","code_information":[{"code":"7367","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.58,"discounted_cash":4.79,"setting":"both","billing_class":"facility"}]},{"description":"BCG 1MG LIVE INTRAVE","code_information":[{"code":"7373","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9030","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.92,"discounted_cash":3.46,"setting":"both","billing_class":"facility"}]},{"description":"OXALIPLATIN 0.5MG J","code_information":[{"code":"7379","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.79,"discounted_cash":1.9,"setting":"both","billing_class":"facility"}]},{"description":"CYANIDE ANTIDOTE KIT","code_information":[{"code":"7382","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":876.4,"discounted_cash":438.2,"setting":"both","billing_class":"facility"}]},{"description":"DALTEPARIN 12500U J","code_information":[{"code":"7392","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1645","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.2,"discounted_cash":23.1,"setting":"both","billing_class":"facility"}]},{"description":"EDROPHONIUM 15ML J","code_information":[{"code":"7396","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.4,"discounted_cash":120.2,"setting":"both","billing_class":"facility"}]},{"description":"LIDOCAINE 1% 50ML J","code_information":[{"code":"7399","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.02,"setting":"both","billing_class":"facility"}]},{"description":"LORAZEPAM 2MG/ML 1ML","code_information":[{"code":"7401","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility"}]},{"description":"FLU VV SPLT 3YR> PFJ","code_information":[{"code":"7405","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q2037","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.82,"discounted_cash":24.91,"setting":"both","billing_class":"facility"}]},{"description":"ATRACURIUM 100MG VJ","code_information":[{"code":"7407","type":"CDM"},{"code":"250","type":"RC"},{"code":"90283","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.45,"discounted_cash":29.73,"setting":"both","billing_class":"facility"}]},{"description":"LIDO 0.5% MPF 50ML","code_information":[{"code":"7423","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.03,"setting":"both","billing_class":"facility"}]},{"description":"HEP FLUSH 1ML VIAL","code_information":[{"code":"7426","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.34,"setting":"both","billing_class":"facility"}]},{"description":"BICCR900/300 100000U","code_information":[{"code":"7433","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.14,"discounted_cash":12.07,"setting":"both","billing_class":"facility"}]},{"description":"BETAMETHASONE 30MG J","code_information":[{"code":"7437","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.53,"discounted_cash":5.76,"setting":"both","billing_class":"facility"}]},{"description":"TRIM/SULF 80/400 J","code_information":[{"code":"7438","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":113.3,"discounted_cash":56.65,"setting":"both","billing_class":"facility"}]},{"description":"LIDO 2% MDV 50ML J","code_information":[{"code":"7442","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.02,"setting":"both","billing_class":"facility"}]},{"description":"AMIOD 450MG/9ML J","code_information":[{"code":"7447","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.63,"setting":"both","billing_class":"facility"}]},{"description":"PARICALC 2MCG/ML J","code_information":[{"code":"7457","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2501","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.53,"discounted_cash":5.76,"setting":"both","billing_class":"facility"}]},{"description":"ROPIVAC .5% 30ML J","code_information":[{"code":"7459","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.57,"discounted_cash":39.28,"setting":"both","billing_class":"facility"}]},{"description":"LIDO MPF 1% 30ML","code_information":[{"code":"7465","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.06,"setting":"both","billing_class":"facility"}]},{"description":"EPINEPH 1MG/10ML","code_information":[{"code":"7477","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1438","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":8.5,"setting":"both","billing_class":"facility"}]},{"description":"ROPIVAC .2% 100ML J","code_information":[{"code":"7482","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.26,"setting":"both","billing_class":"facility"}]},{"description":"FENTANYL 50MCG/ML 50","code_information":[{"code":"7486","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":4.13,"setting":"both","billing_class":"facility"}]},{"description":"CETUXIMAB 10MG J","code_information":[{"code":"7501","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":376.53,"discounted_cash":188.26,"setting":"both","billing_class":"facility"}]},{"description":"CAFF/NA BENZO 2ML J","code_information":[{"code":"7502","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.45,"discounted_cash":27.23,"setting":"both","billing_class":"facility"}]},{"description":"NS PREFILL FLSH 10ML","code_information":[{"code":"7507","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":3.42,"setting":"both","billing_class":"facility"}]},{"description":"MENINGOC VAC ACYW135","code_information":[{"code":"7509","type":"CDM"},{"code":"250","type":"RC"},{"code":"90734","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":282.29,"discounted_cash":141.15,"setting":"both","billing_class":"facility"}]},{"description":"BLEOMYCIN 15UNIT J","code_information":[{"code":"7510","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":265.63,"discounted_cash":132.81,"setting":"both","billing_class":"facility"}]},{"description":"PEGFILGRASTIM/6MG J","code_information":[{"code":"7511","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14393.15,"discounted_cash":7196.57,"setting":"both","billing_class":"facility"}]},{"description":"ADENOS DX 3MG/ML 2ML","code_information":[{"code":"7512","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":251.54,"discounted_cash":125.77,"setting":"both","billing_class":"facility"}]},{"description":"FULVESTRANT 25MG J","code_information":[{"code":"7514","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":294.59,"discounted_cash":147.29,"setting":"both","billing_class":"facility"}]},{"description":"OCTREOTIDE ND 25MCGJ","code_information":[{"code":"7516","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.97,"discounted_cash":7.49,"setting":"both","billing_class":"facility"}]},{"description":"ZIPRASIDONE 10MG J","code_information":[{"code":"7517","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.36,"discounted_cash":38.18,"setting":"both","billing_class":"facility"}]},{"description":"ADENO TX 3MG/ML 2MLJ","code_information":[{"code":"7518","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.33,"discounted_cash":21.16,"setting":"both","billing_class":"facility"}]},{"description":"SOD CL .09% PF 20MLJ","code_information":[{"code":"7521","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"ABATACEPT 250MG J","code_information":[{"code":"7522","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0129","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":98.25,"discounted_cash":49.13,"setting":"both","billing_class":"facility"}]},{"description":"DAPTOMYCIN 1MG J","code_information":[{"code":"7524","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":1.02,"setting":"both","billing_class":"facility"}]},{"description":"LEUPROLIDE ACE 1MG J","code_information":[{"code":"7526","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9218","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":817.75,"discounted_cash":408.88,"setting":"both","billing_class":"facility"}]},{"description":"EPO 1000U NON ESRD J","code_information":[{"code":"7528","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":79.85,"discounted_cash":39.92,"setting":"both","billing_class":"facility"}]},{"description":"DARBEPO NR 500MCG/ML","code_information":[{"code":"7529","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.89,"discounted_cash":8.95,"setting":"both","billing_class":"facility"}]},{"description":"FLU VV SPLT <35MO IM","code_information":[{"code":"7530","type":"CDM"},{"code":"250","type":"RC"},{"code":"90657","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":208.64,"discounted_cash":104.32,"setting":"both","billing_class":"facility"}]},{"description":"TDAP VACC 7YRS> IM","code_information":[{"code":"7533","type":"CDM"},{"code":"250","type":"RC"},{"code":"90715","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":134.02,"discounted_cash":67.01,"setting":"both","billing_class":"facility"}]},{"description":"FLU VV SPLT PF 3YRS>","code_information":[{"code":"7534","type":"CDM"},{"code":"636","type":"RC"},{"code":"90656","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.83,"discounted_cash":30.91,"setting":"both","billing_class":"facility"}]},{"description":"HUMATE P IU J","code_information":[{"code":"7536","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7187","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.13,"discounted_cash":2.56,"setting":"both","billing_class":"facility"}]},{"description":"OLANZAPINE 0.5MG(10)","code_information":[{"code":"7537","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2359","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.64,"discounted_cash":2.82,"setting":"both","billing_class":"facility"}]},{"description":"FLU VACC HD 65+0.7ML","code_information":[{"code":"7541","type":"CDM"},{"code":"636","type":"RC"},{"code":"90662","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":167.49,"discounted_cash":83.75,"setting":"both","billing_class":"facility"}]},{"description":"FLU VACC QUAD 0.5 ML","code_information":[{"code":"7543","type":"CDM"},{"code":"636","type":"RC"},{"code":"90686","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.02,"discounted_cash":29.01,"setting":"both","billing_class":"facility"}]},{"description":"RIFAXAMIN 550 MG TAB","code_information":[{"code":"7544","type":"CDM"},{"code":"250","type":"RC"},{"code":"90686","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.2,"discounted_cash":42.1,"setting":"both","billing_class":"facility"}]},{"description":"LEVETIRACETAM 1000MG","code_information":[{"code":"7545","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.75,"setting":"both","billing_class":"facility"}]},{"description":"LEVETIRACE 500MG PMX","code_information":[{"code":"7546","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.05,"setting":"both","billing_class":"facility"}]},{"description":"BEVACIZUMAB 10MG J","code_information":[{"code":"7547","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":242.41,"discounted_cash":121.2,"setting":"both","billing_class":"facility"}]},{"description":"DIG IMM FAB 40MG V J","code_information":[{"code":"7548","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1162","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8405.41,"discounted_cash":4202.7,"setting":"both","billing_class":"facility"}]},{"description":"ATROPINE 0.4MG 20ML","code_information":[{"code":"7552","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":3.42,"setting":"both","billing_class":"facility"}]},{"description":"IVIG LYOPH 500MG SFJ","code_information":[{"code":"7557","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1566","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":63.5,"setting":"both","billing_class":"facility"}]},{"description":"ACETYLCYS 6GM/30ML J","code_information":[{"code":"7558","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.23,"discounted_cash":3.62,"setting":"both","billing_class":"facility"}]},{"description":"AMINOCAP AC 5G/20MLJ","code_information":[{"code":"7562","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.63,"setting":"both","billing_class":"facility"}]},{"description":"AMIKACIN 1GM/4ML J","code_information":[{"code":"7563","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.48,"discounted_cash":4.74,"setting":"both","billing_class":"facility"}]},{"description":"TRANEXAMIC AC 100MGJ","code_information":[{"code":"7567","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":89.9,"discounted_cash":44.95,"setting":"both","billing_class":"facility"}]},{"description":"LIDO 2% AMP 5ML","code_information":[{"code":"7572","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.06,"setting":"both","billing_class":"facility"}]},{"description":"APIXABAN 5 MG TAB","code_information":[{"code":"7582","type":"CDM"},{"code":"637","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.65,"discounted_cash":8.32,"setting":"both","billing_class":"facility"}]},{"description":"PROCAINE 1% 2ML J","code_information":[{"code":"7584","type":"CDM"},{"code":"250","type":"RC"},{"code":"J8499","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.7,"discounted_cash":6.35,"setting":"both","billing_class":"facility"}]},{"description":"FLUPH DE 25MG/ML 5ML","code_information":[{"code":"7588","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2680","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":358.03,"discounted_cash":179.01,"setting":"both","billing_class":"facility"}]},{"description":"NEOSTIG 1:1000 10MLJ","code_information":[{"code":"7589","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.63,"discounted_cash":8.81,"setting":"both","billing_class":"facility"}]},{"description":"IVIG PRIVIGEN 0.5G J","code_information":[{"code":"7592","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":185.47,"discounted_cash":92.73,"setting":"both","billing_class":"facility"}]},{"description":"NA THIOSULF 25% 50ML","code_information":[{"code":"7595","type":"CDM"},{"code":"250","type":"RC"},{"code":"90396","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":201.1,"discounted_cash":100.55,"setting":"both","billing_class":"facility"}]},{"description":"HYDRMPH 0.2MG/ML PCA","code_information":[{"code":"7599","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.75,"setting":"both","billing_class":"facility"}]},{"description":"METHYLPRED SS 5MG(40","code_information":[{"code":"7614","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":1.36,"setting":"both","billing_class":"facility"}]},{"description":"SECRETIN PWD 16MCG J","code_information":[{"code":"7618","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2850","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.75,"discounted_cash":37.88,"setting":"both","billing_class":"facility"}]},{"description":"OCTREOTIDE .1MG/ML J","code_information":[{"code":"7619","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.58,"discounted_cash":4.79,"setting":"both","billing_class":"facility"}]},{"description":"MORPH 1MG/ML 2ML PFJ","code_information":[{"code":"7621","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.39,"discounted_cash":18.2,"setting":"both","billing_class":"facility"}]},{"description":"INTERF ALFA 2B 50MU","code_information":[{"code":"7622","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9214","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.25,"discounted_cash":34.63,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN  1000U/500ML","code_information":[{"code":"7632","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.08,"discounted_cash":16.04,"setting":"both","billing_class":"facility"}]},{"description":"HEPARIN NA 1000U/30M","code_information":[{"code":"7634","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.87,"discounted_cash":0.44,"setting":"both","billing_class":"facility"}]},{"description":"IRON SUCROSE 1MG J","code_information":[{"code":"7642","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.75,"setting":"both","billing_class":"facility"}]},{"description":"DESMOPRESSIN 1MCG J","code_information":[{"code":"7645","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.74,"discounted_cash":26.37,"setting":"both","billing_class":"facility"}]},{"description":"SOD FERR GLUC 12.5MG","code_information":[{"code":"7646","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.07,"discounted_cash":9.54,"setting":"both","billing_class":"facility"}]},{"description":"VORICONAZOLE 10MG J","code_information":[{"code":"7647","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3465","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.12,"discounted_cash":10.56,"setting":"both","billing_class":"facility"}]},{"description":"ACYCLOVIR 5MG J","code_information":[{"code":"7649","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.26,"setting":"both","billing_class":"facility"}]},{"description":"RISPERID LA 0.5MG J","code_information":[{"code":"7650","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.17,"discounted_cash":8.59,"setting":"both","billing_class":"facility"}]},{"description":"BORTEZOMIB 0.1MG J","code_information":[{"code":"7651","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.59,"discounted_cash":18.3,"setting":"both","billing_class":"facility"}]},{"description":"PALONOSET 25MCG J","code_information":[{"code":"7652","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":272.24,"discounted_cash":136.12,"setting":"both","billing_class":"facility"}]},{"description":"NESIRITIDE 0.1MG J","code_information":[{"code":"7656","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2325","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":162.98,"discounted_cash":81.49,"setting":"both","billing_class":"facility"}]},{"description":"TD TOXOID 0.5ML PF J","code_information":[{"code":"7666","type":"CDM"},{"code":"250","type":"RC"},{"code":"90714","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.4,"discounted_cash":51.2,"setting":"both","billing_class":"facility"}]},{"description":"POT CL 40MEQ/20ML J","code_information":[{"code":"7668","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.82,"discounted_cash":0.41,"setting":"both","billing_class":"facility"}]},{"description":"RABIES IG 1500/10MLJ","code_information":[{"code":"7672","type":"CDM"},{"code":"636","type":"RC"},{"code":"90377","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":767.06,"discounted_cash":383.53,"setting":"both","billing_class":"facility"}]},{"description":"DENOSUMAB 60MG SYR","code_information":[{"code":"7673","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.34,"discounted_cash":38.67,"setting":"both","billing_class":"facility"}]},{"description":"PEMETREXED 10MG J","code_information":[{"code":"7675","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":71.96,"discounted_cash":35.98,"setting":"both","billing_class":"facility"}]},{"description":"HYDROM 1MG SYRG J","code_information":[{"code":"7677","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.46,"setting":"both","billing_class":"facility"}]},{"description":"DARBEPO NR 60MCG J","code_information":[{"code":"7679","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.89,"discounted_cash":8.95,"setting":"both","billing_class":"facility"}]},{"description":"DARBEPO NR 1MCG 100","code_information":[{"code":"7680","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.89,"discounted_cash":8.95,"setting":"both","billing_class":"facility"}]},{"description":"MORPHINE 10MG AMP J","code_information":[{"code":"7681","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.3,"discounted_cash":4.15,"setting":"both","billing_class":"facility"}]},{"description":"IVIG NONLYOPH 500MGJ","code_information":[{"code":"7684","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":179.2,"discounted_cash":89.6,"setting":"both","billing_class":"facility"}]},{"description":"TIGECYCL 1MG J","code_information":[{"code":"7685","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.74,"discounted_cash":2.87,"setting":"both","billing_class":"facility"}]},{"description":"ABRAXANE PBP 1MG J","code_information":[{"code":"7687","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9264","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.07,"discounted_cash":26.04,"setting":"both","billing_class":"facility"}]},{"description":"NALOXONE 2MG/2ML PFS","code_information":[{"code":"7690","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":101.37,"discounted_cash":50.69,"setting":"both","billing_class":"facility"}]},{"description":"HYDROXYZINE 25MG J","code_information":[{"code":"7692","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3410","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.9,"discounted_cash":30.45,"setting":"both","billing_class":"facility"}]},{"description":"FONDAPAR 5MG/0.4ML J","code_information":[{"code":"7694","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.45,"discounted_cash":12.72,"setting":"both","billing_class":"facility"}]},{"description":"FONDAPAR 7.5MG/0.6ML","code_information":[{"code":"7695","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":8.69,"setting":"both","billing_class":"facility"}]},{"description":"FONDAPAR 10MG/0.8MLJ","code_information":[{"code":"7696","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":6.51,"setting":"both","billing_class":"facility"}]},{"description":"EXENATIDE 5MCG/0.02M","code_information":[{"code":"7698","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1644.2,"discounted_cash":822.1,"setting":"both","billing_class":"facility"}]},{"description":"DOPAMINE 40MG 400/10","code_information":[{"code":"7700","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.58,"setting":"both","billing_class":"facility"}]},{"description":"IDARUBICIN 5MG J","code_information":[{"code":"7703","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9211","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.5,"discounted_cash":31.75,"setting":"both","billing_class":"facility"}]},{"description":"PERFLUTREN LIP PERML","code_information":[{"code":"7708","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":370.95,"discounted_cash":185.47,"setting":"both","billing_class":"facility"}]},{"description":"INS DETEMIR 100U/ML","code_information":[{"code":"7709","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":3.25,"setting":"both","billing_class":"facility"}]},{"description":"IVIG NON-LY 5% 100ML","code_information":[{"code":"7716","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1572","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":125.05,"discounted_cash":62.52,"setting":"both","billing_class":"facility"}]},{"description":"TOBRAMYCIN 1.2GM J","code_information":[{"code":"7717","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":26.96,"discounted_cash":13.48,"setting":"both","billing_class":"facility"}]},{"description":"ERTAPENUM 1GM J","code_information":[{"code":"7719","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":148.68,"discounted_cash":74.34,"setting":"both","billing_class":"facility"}]},{"description":"DARBEPOETIN ALFA 300","code_information":[{"code":"7720","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.89,"discounted_cash":8.95,"setting":"both","billing_class":"facility"}]},{"description":"ATROP PED 0.05MG 5ML","code_information":[{"code":"7721","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":47.55,"discounted_cash":23.77,"setting":"both","billing_class":"facility"}]},{"description":"LIDO BUFFERED 2% 5ML","code_information":[{"code":"7722","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.65,"discounted_cash":7.83,"setting":"both","billing_class":"facility"}]},{"description":"LEUPROLIDE 11.25MG J","code_information":[{"code":"7723","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3000.89,"discounted_cash":1500.44,"setting":"both","billing_class":"facility"}]},{"description":"KENALOG 40MG/ML 1MLV","code_information":[{"code":"7724","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":338.65,"discounted_cash":169.32,"setting":"both","billing_class":"facility"}]},{"description":"TRYPN BL 0.06% 0.5ML","code_information":[{"code":"7725","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":152.1,"discounted_cash":76.05,"setting":"both","billing_class":"facility"}]},{"description":"OCTREOTIDE 10MG J","code_information":[{"code":"7726","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":751.89,"discounted_cash":375.94,"setting":"both","billing_class":"facility"}]},{"description":"OCTREOTIDE 20MG J","code_information":[{"code":"7727","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":248.0,"setting":"both","billing_class":"facility"}]},{"description":"OCTREOTIDE 30MG J","code_information":[{"code":"7728","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":491.69,"discounted_cash":245.84,"setting":"both","billing_class":"facility"}]},{"description":"RELISTOR 0.1MG(12MG)","code_information":[{"code":"7729","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.86,"discounted_cash":1.43,"setting":"both","billing_class":"facility"}]},{"description":"ADENOS DX 3MG/ML 3ML","code_information":[{"code":"7730","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.23,"discounted_cash":65.11,"setting":"both","billing_class":"facility"}]},{"description":"AZACITIDINE 100MG J","code_information":[{"code":"7731","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.01,"discounted_cash":12.51,"setting":"both","billing_class":"facility"}]},{"description":"DECITABINE 50MG J","code_information":[{"code":"7732","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.45,"discounted_cash":29.73,"setting":"both","billing_class":"facility"}]},{"description":"DOXERCAL 4MCG/2ML J","code_information":[{"code":"7733","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1270","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":4.13,"setting":"both","billing_class":"facility"}]},{"description":"EPO 40000U/ML J SDV","code_information":[{"code":"7734","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.29,"discounted_cash":32.65,"setting":"both","billing_class":"facility"}]},{"description":"FOSAPREPIT 150MG J","code_information":[{"code":"7735","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.38,"discounted_cash":6.69,"setting":"both","billing_class":"facility"}]},{"description":"IBANDRON 3MG/3ML J","code_information":[{"code":"7736","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1740","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":324.21,"discounted_cash":162.1,"setting":"both","billing_class":"facility"}]},{"description":"LEVETIRA 500MG/5ML","code_information":[{"code":"7737","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.82,"discounted_cash":0.41,"setting":"both","billing_class":"facility"}]},{"description":"NATALIZUM 300MG/15ML","code_information":[{"code":"7738","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2323","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.18,"discounted_cash":24.09,"setting":"both","billing_class":"facility"}]},{"description":"REGADEN 0.4MG/5ML J","code_information":[{"code":"7739","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.94,"discounted_cash":69.47,"setting":"both","billing_class":"facility"}]},{"description":"MICAFUNGIN 100MG J","code_information":[{"code":"7740","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2248","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.31,"discounted_cash":2.15,"setting":"both","billing_class":"facility"}]},{"description":"EXENATIDE 10MCG/0.04","code_information":[{"code":"7742","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2796","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1644.25,"discounted_cash":822.13,"setting":"both","billing_class":"facility"}]},{"description":"PROPOFOL 10MG/ML20ML","code_information":[{"code":"7743","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.18,"setting":"both","billing_class":"facility"}]},{"description":"DARBEPO NR 200MCG J","code_information":[{"code":"7744","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.89,"discounted_cash":8.95,"setting":"both","billing_class":"facility"}]},{"description":"NS FLUSH 10ML STRL","code_information":[{"code":"7745","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"HEP FLUSH 100U/5ML","code_information":[{"code":"7746","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.1,"discounted_cash":0.05,"setting":"both","billing_class":"facility"}]},{"description":"ARIPIP 9.75MG/1.3MLJ","code_information":[{"code":"7747","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0400","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":1.1,"setting":"both","billing_class":"facility"}]},{"description":"ENLIVE COMPACT 120ML","code_information":[{"code":"7748","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0400","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":1.95,"setting":"both","billing_class":"facility"}]},{"description":"TOCILIZUMAB 200MG J","code_information":[{"code":"7750","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.81,"discounted_cash":6.41,"setting":"both","billing_class":"facility"}]},{"description":"ACETAM 10MG/ML 100ML","code_information":[{"code":"7751","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.62,"setting":"both","billing_class":"facility"}]},{"description":"PHENYLEPHRINE 20 MCG","code_information":[{"code":"7752","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.18,"setting":"both","billing_class":"facility"}]},{"description":"YERVOY 50 MG/10 ML J","code_information":[{"code":"7753","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9228","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.51,"discounted_cash":166.25,"setting":"both","billing_class":"facility"}]},{"description":"TOCILIZUMAB 80MG J","code_information":[{"code":"7754","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.81,"discounted_cash":6.41,"setting":"both","billing_class":"facility"}]},{"description":"PALIPERIDONE 234MG J","code_information":[{"code":"7755","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2426","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.73,"discounted_cash":10.87,"setting":"both","billing_class":"facility"}]},{"description":"CARFILZOMIB 60MG J","code_information":[{"code":"7756","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9047","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":131.41,"discounted_cash":65.7,"setting":"both","billing_class":"facility"}]},{"description":"PALIPERIDONE 156MG J","code_information":[{"code":"7757","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2426","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":21.42,"discounted_cash":10.71,"setting":"both","billing_class":"facility"}]},{"description":"TILMANOCEPT","code_information":[{"code":"7758","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9520","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1466.66,"discounted_cash":733.33,"setting":"both","billing_class":"facility"}]},{"description":"PEGFILGRASTIM NEULAS","code_information":[{"code":"7759","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1145.95,"discounted_cash":572.98,"setting":"both","billing_class":"facility"}]},{"description":"PEGFILGRASTIM ONPRO","code_information":[{"code":"7760","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1145.95,"discounted_cash":572.98,"setting":"both","billing_class":"facility"}]},{"description":"DOXORB LIPOSM 20MG J","code_information":[{"code":"7761","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1516.74,"discounted_cash":758.37,"setting":"both","billing_class":"facility"}]},{"description":"GLYCOPYR 1MG/5ML SYR","code_information":[{"code":"7762","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.8,"discounted_cash":9.4,"setting":"both","billing_class":"facility"}]},{"description":"GLYCPY 0.1(0.6/3) SY","code_information":[{"code":"7763","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":3.38,"setting":"both","billing_class":"facility"}]},{"description":"SUCCYLC 200MG/10MLSY","code_information":[{"code":"7764","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.31,"discounted_cash":2.15,"setting":"both","billing_class":"facility"}]},{"description":"NIVOLUMAB 10 MG/ML","code_information":[{"code":"7765","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.87,"discounted_cash":40.44,"setting":"both","billing_class":"facility"}]},{"description":"NIVOLUMAB 10MG/ML 40","code_information":[{"code":"7766","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.92,"discounted_cash":40.46,"setting":"both","billing_class":"facility"}]},{"description":"NIVOLUMAB 10MGML 240","code_information":[{"code":"7767","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":82.05,"discounted_cash":41.02,"setting":"both","billing_class":"facility"}]},{"description":"DEXMEDETOMIDINE 200M","code_information":[{"code":"7768","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.2,"discounted_cash":28.6,"setting":"both","billing_class":"facility"}]},{"description":"TOCILIZ 1MG 80 COVID","code_information":[{"code":"7769","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0249","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.97,"discounted_cash":6.49,"setting":"both","billing_class":"facility"}]},{"description":"CARFILZOMIB KYPROLIS","code_information":[{"code":"7770","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9047","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":122.44,"discounted_cash":61.22,"setting":"both","billing_class":"facility"}]},{"description":"NEBIVOLOL BYSTOLIC","code_information":[{"code":"7771","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.84,"discounted_cash":5.92,"setting":"both","billing_class":"facility"}]},{"description":"VECURONIUM 20MG INJ","code_information":[{"code":"7772","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":49.7,"discounted_cash":24.85,"setting":"both","billing_class":"facility"}]},{"description":"VECURONIUM DRIP 100","code_information":[{"code":"7773","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":170.55,"discounted_cash":85.28,"setting":"both","billing_class":"facility"}]},{"description":"PEGFILGRASTIM-BMEZ 6","code_information":[{"code":"7774","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5120","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":736.36,"discounted_cash":368.18,"setting":"both","billing_class":"facility"}]},{"description":"ROMIDEPSIN 0.1 MG J","code_information":[{"code":"7775","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9319","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":91.12,"discounted_cash":45.56,"setting":"both","billing_class":"facility"}]},{"description":"INSULIN GLARGINE-YFG","code_information":[{"code":"7776","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.54,"setting":"both","billing_class":"facility"}]},{"description":"REMDESIVIR 1 MG J","code_information":[{"code":"7777","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0248","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.11,"discounted_cash":15.55,"setting":"both","billing_class":"facility"}]},{"description":"CEMIPLAMAB RWLC 1MG","code_information":[{"code":"7778","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9119","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.14,"discounted_cash":28.57,"setting":"both","billing_class":"facility"}]},{"description":"GEMCITABINE 200 MG J","code_information":[{"code":"7781","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":71.75,"discounted_cash":35.88,"setting":"both","billing_class":"facility"}]},{"description":"DENOSUMAB 70 MG/ML J","code_information":[{"code":"7782","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.76,"discounted_cash":28.88,"setting":"both","billing_class":"facility"}]},{"description":"IFOSFAMIDE 3 GM J","code_information":[{"code":"7783","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.1,"discounted_cash":42.05,"setting":"both","billing_class":"facility"}]},{"description":"IRINOTCN 100MG/5ML J","code_information":[{"code":"7784","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.15,"discounted_cash":26.57,"setting":"both","billing_class":"facility"}]},{"description":"OXLIPLTN 100MG/20MLJ","code_information":[{"code":"7785","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.51,"discounted_cash":3.25,"setting":"both","billing_class":"facility"}]},{"description":"PEMETREXED 500 MG J","code_information":[{"code":"7786","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":200.54,"discounted_cash":100.27,"setting":"both","billing_class":"facility"}]},{"description":"IXABEPILONE 15 MG J","code_information":[{"code":"7787","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9207","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":347.07,"discounted_cash":173.53,"setting":"both","billing_class":"facility"}]},{"description":"CLOFARABINE 20 MG J","code_information":[{"code":"7788","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9027","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":344.55,"discounted_cash":172.28,"setting":"both","billing_class":"facility"}]},{"description":"PANITUMUMAB 100 MG J","code_information":[{"code":"7789","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":287.15,"discounted_cash":143.57,"setting":"both","billing_class":"facility"}]},{"description":"PENTOSTATIN 10 MG J","code_information":[{"code":"7790","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9268","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5180.66,"discounted_cash":2590.33,"setting":"both","billing_class":"facility"}]},{"description":"ROMIDPSN 0.1MG(10MG)","code_information":[{"code":"7791","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9319","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.77,"discounted_cash":43.38,"setting":"both","billing_class":"facility"}]},{"description":"TEMSIROLIMUS 25 MG J","code_information":[{"code":"7792","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9330","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":166.15,"discounted_cash":83.08,"setting":"both","billing_class":"facility"}]},{"description":"CABAZITAXEL 60 MG J","code_information":[{"code":"7793","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9043","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":423.17,"discounted_cash":211.59,"setting":"both","billing_class":"facility"}]},{"description":"TREANDA 25 MG","code_information":[{"code":"7794","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9033","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":93.02,"discounted_cash":46.51,"setting":"both","billing_class":"facility"}]},{"description":"TREANDA 100MG","code_information":[{"code":"7795","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9033","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":93.02,"discounted_cash":46.51,"setting":"both","billing_class":"facility"}]},{"description":"ADO-TRSTZUMB 100MG J","code_information":[{"code":"7796","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9354","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":92.81,"discounted_cash":46.41,"setting":"both","billing_class":"facility"}]},{"description":"BRENTUXIMAB 50 MG J","code_information":[{"code":"7797","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9042","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":359.67,"discounted_cash":179.84,"setting":"both","billing_class":"facility"}]},{"description":"PRALATREXATE 20 MG J","code_information":[{"code":"7798","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9307","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":648.57,"discounted_cash":324.29,"setting":"both","billing_class":"facility"}]},{"description":"PERTUZUMAB EA 1 MG J","code_information":[{"code":"7799","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9306","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":27.32,"discounted_cash":13.66,"setting":"both","billing_class":"facility"}]},{"description":"TISSMND XCR PER SQCM","code_information":[{"code":"7804","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5053.71,"discounted_cash":2526.86,"setting":"both","billing_class":"facility"}]},{"description":"NEOX 1K PER SQ CM","code_information":[{"code":"7811","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4148","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":24654.99,"discounted_cash":12327.5,"setting":"both","billing_class":"facility"}]},{"description":"BUPRENORPHINE 2MG TB","code_information":[{"code":"7813","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4116","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.3,"discounted_cash":2.15,"setting":"both","billing_class":"facility"}]},{"description":"BUPREN/NAXOLOXONE","code_information":[{"code":"7814","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q4116","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.3,"discounted_cash":4.65,"setting":"both","billing_class":"facility"}]},{"description":"TH HYDROC AP 5/325 T","code_information":[{"code":"7817","type":"CDM"},{"code":"259","type":"RC"},{"code":"Q4116","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.3,"discounted_cash":8.15,"setting":"both","billing_class":"facility"}]},{"description":"TH APAP W/COD TAB","code_information":[{"code":"7821","type":"CDM"},{"code":"253","type":"RC"},{"code":"Q4116","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility"}]},{"description":"TH TRAMADOL 50MG T","code_information":[{"code":"7834","type":"CDM"},{"code":"253","type":"RC"},{"code":"Q4116","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.9,"discounted_cash":4.95,"setting":"both","billing_class":"facility"}]},{"description":"TH CYCLOBENZ 10MG T","code_information":[{"code":"7835","type":"CDM"},{"code":"253","type":"RC"},{"code":"Q4116","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.85,"discounted_cash":4.92,"setting":"both","billing_class":"facility"}]},{"description":"TH SMX TMP DS TAB","code_information":[{"code":"7836","type":"CDM"},{"code":"253","type":"RC"},{"code":"Q4116","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":5.6,"setting":"both","billing_class":"facility"}]},{"description":"TH IBUPROPHEN 600MGT","code_information":[{"code":"7837","type":"CDM"},{"code":"253","type":"RC"},{"code":"Q4116","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.9,"discounted_cash":7.95,"setting":"both","billing_class":"facility"}]},{"description":"TH OXYCODONE/APAP T","code_information":[{"code":"7838","type":"CDM"},{"code":"259","type":"RC"},{"code":"Q4116","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":8.13,"setting":"both","billing_class":"facility"}]},{"description":"TH ONDANSET 4MG T","code_information":[{"code":"7839","type":"CDM"},{"code":"259","type":"RC"},{"code":"Q4116","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"TH PROMETH 25MG T","code_information":[{"code":"7840","type":"CDM"},{"code":"253","type":"RC"},{"code":"Q4116","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.4,"discounted_cash":8.2,"setting":"both","billing_class":"facility"}]},{"description":"TICAGRELOR 90 MG TAB","code_information":[{"code":"7841","type":"CDM"},{"code":"637","type":"RC"},{"code":"Q4116","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.9,"discounted_cash":6.95,"setting":"both","billing_class":"facility"}]},{"description":"BUPI LIPOS 1.3% 20ML","code_information":[{"code":"7842","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0666","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.77,"discounted_cash":1.39,"setting":"both","billing_class":"facility"}]},{"description":"NECITUMUMAB 1MG","code_information":[{"code":"7843","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9295","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.02,"discounted_cash":5.51,"setting":"both","billing_class":"facility"}]},{"description":"BENDEKA 25MG/ML 4 ML","code_information":[{"code":"7844","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9034","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.13,"discounted_cash":38.56,"setting":"both","billing_class":"facility"}]},{"description":"ALTEPLASE 50 MG","code_information":[{"code":"7846","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":206.64,"discounted_cash":103.32,"setting":"both","billing_class":"facility"}]},{"description":"KEYTRUDA 25 MG/ML","code_information":[{"code":"7847","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.54,"discounted_cash":62.27,"setting":"both","billing_class":"facility"}]},{"description":"OBINUTUZUMB 1GM/40ML","code_information":[{"code":"7848","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9301","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.6,"discounted_cash":75.8,"setting":"both","billing_class":"facility"}]},{"description":"FERRC CARXM 750MG/15","code_information":[{"code":"7849","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1439","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.13,"discounted_cash":1.56,"setting":"both","billing_class":"facility"}]},{"description":"FRMXTL 510MG NO-ESRD","code_information":[{"code":"7850","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0138","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.02,"discounted_cash":5.51,"setting":"both","billing_class":"facility"}]},{"description":"FERUMXYTL 510MG ESRD","code_information":[{"code":"7851","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0139","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1567.33,"discounted_cash":783.66,"setting":"both","billing_class":"facility"}]},{"description":"PREVNAR 13 VAC .5 ML","code_information":[{"code":"7852","type":"CDM"},{"code":"636","type":"RC"},{"code":"90670","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":447.77,"discounted_cash":223.88,"setting":"both","billing_class":"facility"}]},{"description":"ARGATROBN 1MG(250MG)","code_information":[{"code":"7853","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0883","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.28,"discounted_cash":3.64,"setting":"both","billing_class":"facility"}]},{"description":"HYALURONIDASE 150 UN","code_information":[{"code":"7855","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3473","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.56,"setting":"both","billing_class":"facility"}]},{"description":"LANREOTIDE 1MG (120)","code_information":[{"code":"7856","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1932","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":139.71,"discounted_cash":69.86,"setting":"both","billing_class":"facility"}]},{"description":"ORITAVANCIN 10 MG J","code_information":[{"code":"7857","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2407","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":58.43,"discounted_cash":29.21,"setting":"both","billing_class":"facility"}]},{"description":"DEXMTH 100MG/10ML MD","code_information":[{"code":"7858","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.87,"discounted_cash":0.44,"setting":"both","billing_class":"facility"}]},{"description":"ERIBULIN 0.1 MG J","code_information":[{"code":"7859","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9179","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.79,"discounted_cash":212.9,"setting":"both","billing_class":"facility"}]},{"description":"FLUT/SALM HFA 115-21","code_information":[{"code":"7860","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9179","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.6,"discounted_cash":6.8,"setting":"both","billing_class":"facility"}]},{"description":"FLUT/SALM HFA 230-21","code_information":[{"code":"7861","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9179","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":20.05,"discounted_cash":10.03,"setting":"both","billing_class":"facility"}]},{"description":"FLUT/SALM HFA 44-21","code_information":[{"code":"7862","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9179","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":13.6,"discounted_cash":6.8,"setting":"both","billing_class":"facility"}]},{"description":"LEVALBUTEROL HFA 45","code_information":[{"code":"7863","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9179","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"FLUTICASONE HFA 110","code_information":[{"code":"7864","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9179","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.3,"discounted_cash":4.15,"setting":"both","billing_class":"facility"}]},{"description":"FLUTICASONE HFA 44","code_information":[{"code":"7865","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9179","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.13,"setting":"both","billing_class":"facility"}]},{"description":"FILGRASTIM 1MCG J","code_information":[{"code":"7866","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.23,"discounted_cash":2.62,"setting":"both","billing_class":"facility"}]},{"description":"GRANIX 1MCG 480MCG","code_information":[{"code":"7867","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.98,"setting":"both","billing_class":"facility"}]},{"description":"OCRELIZUMAB 1MG","code_information":[{"code":"7868","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2350","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.58,"discounted_cash":69.29,"setting":"both","billing_class":"facility"}]},{"description":"TIXABEVIMAB CILGAVIM","code_information":[{"code":"7870","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0220","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"BAMLANIVIMAB ETESEV","code_information":[{"code":"7873","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0245","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"REGEN-COV","code_information":[{"code":"7874","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0244","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"SUGAMMADEX BRIDION 5","code_information":[{"code":"7875","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":453.26,"discounted_cash":226.63,"setting":"both","billing_class":"facility"}]},{"description":"SUGAMMADEX BRIDION 2","code_information":[{"code":"7876","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":247.49,"discounted_cash":123.75,"setting":"both","billing_class":"facility"}]},{"description":"PANHEMATIN HEMIN 350","code_information":[{"code":"7877","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1640","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":52.74,"discounted_cash":26.37,"setting":"both","billing_class":"facility"}]},{"description":"DARATUMUMAB 10 MG J","code_information":[{"code":"7878","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":165.79,"discounted_cash":82.89,"setting":"both","billing_class":"facility"}]},{"description":"SACUBITRIL 24MG/26MG","code_information":[{"code":"7879","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.65,"discounted_cash":9.32,"setting":"both","billing_class":"facility"}]},{"description":"SACUBITRIL 49MG/51MG","code_information":[{"code":"7880","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.6,"discounted_cash":8.8,"setting":"both","billing_class":"facility"}]},{"description":"SACUBITRIL 97MG103MG","code_information":[{"code":"7881","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.6,"discounted_cash":8.8,"setting":"both","billing_class":"facility"}]},{"description":"ADOTRASTUZUMAB 160MG","code_information":[{"code":"7882","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9354","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":92.81,"discounted_cash":46.41,"setting":"both","billing_class":"facility"}]},{"description":"PERCOCET 7.5MG/325MG","code_information":[{"code":"7883","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9354","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":2.52,"setting":"both","billing_class":"facility"}]},{"description":"PERCOCET 10MG/325MG","code_information":[{"code":"7884","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9354","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.45,"discounted_cash":3.23,"setting":"both","billing_class":"facility"}]},{"description":"BURPRENORPHINE NALOX","code_information":[{"code":"7885","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0574","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.53,"discounted_cash":9.77,"setting":"both","billing_class":"facility"}]},{"description":"ELOTUZUMAB 300 MG","code_information":[{"code":"7888","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9176","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.53,"discounted_cash":9.77,"setting":"both","billing_class":"facility"}]},{"description":"ELOTUZUMAB 400 MG","code_information":[{"code":"7889","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9176","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.48,"discounted_cash":9.74,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE 300 30 ML","code_information":[{"code":"7890","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":1.1,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE M 300 15 ML","code_information":[{"code":"7891","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.41,"discounted_cash":4.21,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE 300 50 ML","code_information":[{"code":"7892","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.69,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE 300 150 ML","code_information":[{"code":"7893","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.67,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE 300 100 ML","code_information":[{"code":"7894","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.67,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE 300 75 ML","code_information":[{"code":"7895","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.75,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE 300MG 10/75ML","code_information":[{"code":"7896","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.75,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE 370 100 ML","code_information":[{"code":"7897","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.75,"setting":"both","billing_class":"facility"}]},{"description":"CYSTOGRAFIN 300 ML","code_information":[{"code":"7898","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.13,"setting":"both","billing_class":"facility"}]},{"description":"PROHANCE 5 ML","code_information":[{"code":"7899","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9579","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.38,"discounted_cash":4.69,"setting":"both","billing_class":"facility"}]},{"description":"PROHANCE 10 ML","code_information":[{"code":"7900","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9579","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.38,"discounted_cash":4.69,"setting":"both","billing_class":"facility"}]},{"description":"PROHANCE 17 ML","code_information":[{"code":"7901","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9579","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.51,"discounted_cash":4.25,"setting":"both","billing_class":"facility"}]},{"description":"VISIPAQUE 320 50 ML","code_information":[{"code":"7902","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.9,"setting":"both","billing_class":"facility"}]},{"description":"VISIPAQUE 320 150 ML","code_information":[{"code":"7903","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.82,"setting":"both","billing_class":"facility"}]},{"description":"CONRAY 43 50ML","code_information":[{"code":"7904","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.46,"discounted_cash":0.23,"setting":"both","billing_class":"facility"}]},{"description":"SODIUM CHL 0.9% 20ML","code_information":[{"code":"7905","type":"CDM"},{"code":"636","type":"RC"},{"code":"A4216","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.51,"discounted_cash":3.25,"setting":"both","billing_class":"facility"}]},{"description":"EPHEDRINE 50MG/ML 1M","code_information":[{"code":"7906","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":117.98,"discounted_cash":58.99,"setting":"both","billing_class":"facility"}]},{"description":"PROHANCE 50ML","code_information":[{"code":"7909","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9579","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.84,"discounted_cash":2.92,"setting":"both","billing_class":"facility"}]},{"description":"ARSENIC TRIOXIDE 1MG","code_information":[{"code":"7910","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":285.1,"discounted_cash":142.55,"setting":"both","billing_class":"facility"}]},{"description":"GRANIX 1MCG 300MCG","code_information":[{"code":"7911","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.98,"setting":"both","billing_class":"facility"}]},{"description":"XEROFORM 1 X 8","code_information":[{"code":"7912","type":"CDM"},{"code":"623","type":"RC"},{"code":"A6222","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.1,"setting":"both","billing_class":"facility"}]},{"description":"DARBOPOETIN 1MCG 40","code_information":[{"code":"7914","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.45,"discounted_cash":9.22,"setting":"both","billing_class":"facility"}]},{"description":"DARBOPOETIN 25 MCG","code_information":[{"code":"7915","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.19,"discounted_cash":9.1,"setting":"both","billing_class":"facility"}]},{"description":"CLINIMIX 5%/D15% 1 L","code_information":[{"code":"7916","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":132.4,"discounted_cash":66.2,"setting":"both","billing_class":"facility"}]},{"description":"CLINIMIX E 5%/D15%/L","code_information":[{"code":"7917","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":134.6,"discounted_cash":67.3,"setting":"both","billing_class":"facility"}]},{"description":"PEGFILGRASTIM JMDB.5","code_information":[{"code":"7918","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5108","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":816.93,"discounted_cash":408.46,"setting":"both","billing_class":"facility"}]},{"description":"GAMUNEX IVIG 500MG","code_information":[{"code":"7919","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":136.48,"discounted_cash":68.24,"setting":"both","billing_class":"facility"}]},{"description":"EPOETIN ALFA-2000U/M","code_information":[{"code":"7920","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.83,"discounted_cash":12.91,"setting":"both","billing_class":"facility"}]},{"description":"EPOETIN ALFA 3000U/M","code_information":[{"code":"7921","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.78,"discounted_cash":12.89,"setting":"both","billing_class":"facility"}]},{"description":"ATEZOLIZUMAB 10MG IN","code_information":[{"code":"7922","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9022","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.74,"discounted_cash":86.87,"setting":"both","billing_class":"facility"}]},{"description":"DURVALUMAB 10MG INJ","code_information":[{"code":"7923","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9173","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":167.08,"discounted_cash":83.54,"setting":"both","billing_class":"facility"}]},{"description":"DURVALUMAB 10 MG INJ","code_information":[{"code":"7924","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9173","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":167.08,"discounted_cash":83.54,"setting":"both","billing_class":"facility"}]},{"description":"EPOETIN ALFA 4000U/M","code_information":[{"code":"7925","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.83,"discounted_cash":12.91,"setting":"both","billing_class":"facility"}]},{"description":"EPOETINALFA 10000U/M","code_information":[{"code":"7926","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.78,"discounted_cash":12.89,"setting":"both","billing_class":"facility"}]},{"description":"EPOETIN ALFA40000U/M","code_information":[{"code":"7927","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.78,"discounted_cash":12.89,"setting":"both","billing_class":"facility"}]},{"description":"ADYNOVATE 1 IU","code_information":[{"code":"7928","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7207","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.46,"discounted_cash":4.23,"setting":"both","billing_class":"facility"}]},{"description":"ECULIZUMAB 10MG","code_information":[{"code":"7929","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1300","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":510.5,"discounted_cash":255.25,"setting":"both","billing_class":"facility"}]},{"description":"GADOXETATE 181.4MG","code_information":[{"code":"7930","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9581","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.24,"discounted_cash":11.12,"setting":"both","billing_class":"facility"}]},{"description":"RASBURICASE 1.5MG V","code_information":[{"code":"7931","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2783","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.44,"discounted_cash":445.72,"setting":"both","billing_class":"facility"}]},{"description":"DOXORUBCN LPSMA 50MG","code_information":[{"code":"7932","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1516.8,"discounted_cash":758.4,"setting":"both","billing_class":"facility"}]},{"description":"ISOVUE-370 SD 76% 50","code_information":[{"code":"7933","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":149.65,"discounted_cash":74.83,"setting":"both","billing_class":"facility"}]},{"description":"PEGLOTICASE 8 MG/1 M","code_information":[{"code":"7934","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2507","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6323.84,"discounted_cash":3161.92,"setting":"both","billing_class":"facility"}]},{"description":"AKYNZEO 235-0.25 MG","code_information":[{"code":"7935","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1454","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3339.4,"discounted_cash":1669.7,"setting":"both","billing_class":"facility"}]},{"description":"LEUPROLIDE 30 MG J","code_information":[{"code":"7936","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1346.75,"discounted_cash":673.38,"setting":"both","billing_class":"facility"}]},{"description":"VASCEPA 1GM CAP","code_information":[{"code":"7937","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":2.7,"setting":"both","billing_class":"facility"}]},{"description":"APREPITANT 130 MG J","code_information":[{"code":"7938","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0185","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":8.04,"setting":"both","billing_class":"facility"}]},{"description":"TRASTUZUMAB ANNS","code_information":[{"code":"7939","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5117","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":198.44,"discounted_cash":99.22,"setting":"both","billing_class":"facility"}]},{"description":"FLUAD 0.5 ML FLU 65+","code_information":[{"code":"7940","type":"CDM"},{"code":"636","type":"RC"},{"code":"90653","type":"CPT"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":155.9,"discounted_cash":77.95,"setting":"both","billing_class":"facility"}]},{"description":"BEVACIZUMAB AWWB","code_information":[{"code":"7941","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":201.98,"discounted_cash":100.99,"setting":"both","billing_class":"facility"}]},{"description":"FLUTICASONE/VILANTER","code_information":[{"code":"7942","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3535","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":302.53,"discounted_cash":151.26,"setting":"both","billing_class":"facility"}]},{"description":"FLUTICASONE FUROATE","code_information":[{"code":"7943","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3535","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":181.07,"discounted_cash":90.53,"setting":"both","billing_class":"facility"}]},{"description":"GLYCOPYRROLATE SEEBR","code_information":[{"code":"7944","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3535","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.15,"discounted_cash":44.08,"setting":"both","billing_class":"facility"}]},{"description":"RIVAROXABAN 2.5 MG T","code_information":[{"code":"7945","type":"CDM"},{"code":"637","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":6.47,"setting":"both","billing_class":"facility"}]},{"description":"RITUXIMAB-ABBS 10MG","code_information":[{"code":"7946","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":335.43,"discounted_cash":167.72,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 750 MG VI","code_information":[{"code":"7947","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.6,"discounted_cash":9.3,"setting":"both","billing_class":"facility"}]},{"description":"KETAMINE 10 MG/ML 20","code_information":[{"code":"7948","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.45,"discounted_cash":29.73,"setting":"both","billing_class":"facility"}]},{"description":"BELATACEPT 250 MG J","code_information":[{"code":"7949","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0485","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14.86,"discounted_cash":7.43,"setting":"both","billing_class":"facility"}]},{"description":"CALC GLUC 10MG(200)/","code_information":[{"code":"7950","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0613","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.36,"setting":"both","billing_class":"facility"}]},{"description":"CALC GLUC 10MG(100)","code_information":[{"code":"7951","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0613","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.36,"setting":"both","billing_class":"facility"}]},{"description":"MIRABEGRON 25 MG ER","code_information":[{"code":"7952","type":"CDM"},{"code":"637","type":"RC"},{"code":"J0613","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":15.5,"setting":"both","billing_class":"facility"}]},{"description":"INJECT ZARXIO 1 MCG","code_information":[{"code":"7953","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.93,"setting":"both","billing_class":"facility"}]},{"description":"LOKELMA 5GM","code_information":[{"code":"7954","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.8,"discounted_cash":25.4,"setting":"both","billing_class":"facility"}]},{"description":"LEUPROLIDE 45MG 6M0","code_information":[{"code":"7955","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1414.19,"discounted_cash":707.1,"setting":"both","billing_class":"facility"}]},{"description":"REMDESIVIR 100 MG","code_information":[{"code":"7957","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0248","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2661.05,"discounted_cash":1330.53,"setting":"both","billing_class":"facility"}]},{"description":"RAMUCIRUMAB 5 MG J","code_information":[{"code":"7958","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9308","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":142.22,"discounted_cash":71.11,"setting":"both","billing_class":"facility"}]},{"description":"ENHERTU 1 MG","code_information":[{"code":"7959","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9358","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":71.9,"discounted_cash":35.95,"setting":"both","billing_class":"facility"}]},{"description":"ORTHO COCKTAIL CLON","code_information":[{"code":"7960","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9358","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":59.65,"discounted_cash":29.82,"setting":"both","billing_class":"facility"}]},{"description":"SACITUZUMAB GOVITECA","code_information":[{"code":"7961","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9317","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.41,"discounted_cash":42.2,"setting":"both","billing_class":"facility"}]},{"description":"CASIRIVIMAB IMDEVIMA","code_information":[{"code":"7963","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0243","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"ASCORBIC ACID 500 MG","code_information":[{"code":"7970","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":858.85,"discounted_cash":429.43,"setting":"both","billing_class":"facility"}]},{"description":"TRASTUZUMAB-HYALURON","code_information":[{"code":"7971","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9356","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":174.76,"discounted_cash":87.38,"setting":"both","billing_class":"facility"}]},{"description":"CHOLECALCIFEROL VITD","code_information":[{"code":"7972","type":"CDM"},{"code":"637","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.6,"setting":"both","billing_class":"facility"}]},{"description":"ATIVAN 40MG/10ML MDV","code_information":[{"code":"7973","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.12,"discounted_cash":27.06,"setting":"both","billing_class":"facility"}]},{"description":"RITUXIMAB-PVVR 10 MG","code_information":[{"code":"7974","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":160.77,"discounted_cash":80.39,"setting":"both","billing_class":"facility"}]},{"description":"TRASTUZUMAB-QYYP","code_information":[{"code":"7975","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5116","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":181.12,"discounted_cash":90.56,"setting":"both","billing_class":"facility"}]},{"description":"BEVACIZUMAB-BVZR 10","code_information":[{"code":"7976","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5118","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":182.91,"discounted_cash":91.45,"setting":"both","billing_class":"facility"}]},{"description":"ENFORTUMAB-VEDOTIN20","code_information":[{"code":"7977","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9177","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":81.69,"discounted_cash":40.84,"setting":"both","billing_class":"facility"}]},{"description":"ENFORTUMAB VEDOTIN30","code_information":[{"code":"7978","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9177","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":81.69,"discounted_cash":40.84,"setting":"both","billing_class":"facility"}]},{"description":"MISOPROSTOL 25MCG","code_information":[{"code":"7979","type":"CDM"},{"code":"250","type":"RC"},{"code":"J9177","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"LEVETIRACETAM 500 LQ","code_information":[{"code":"7981","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0245","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.7,"discounted_cash":6.35,"setting":"both","billing_class":"facility"}]},{"description":"SOTROVIMAB 500 MG","code_information":[{"code":"7982","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0247","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"OLUMIANT BARICITINIB","code_information":[{"code":"7983","type":"CDM"},{"code":"637","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":174.1,"discounted_cash":87.05,"setting":"both","billing_class":"facility"}]},{"description":"DARZALEX FASPRO 1800","code_information":[{"code":"7984","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9144","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":99.53,"discounted_cash":49.77,"setting":"both","billing_class":"facility"}]},{"description":"PEMETREXED PEMFEXY10","code_information":[{"code":"7985","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9304","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":164.87,"discounted_cash":82.44,"setting":"both","billing_class":"facility"}]},{"description":"RITUXAN HYCELA 1400","code_information":[{"code":"7986","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9311","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":100.6,"discounted_cash":50.3,"setting":"both","billing_class":"facility"}]},{"description":"LEQVIO INJ 1MG/1.5","code_information":[{"code":"7987","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1306","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.14,"discounted_cash":12.07,"setting":"both","billing_class":"facility"}]},{"description":"INFLECTRA DYYB 100MG","code_information":[{"code":"7989","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5103","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility"}]},{"description":"FILGRASTIM-SNDZ 300M","code_information":[{"code":"7990","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":1.02,"setting":"both","billing_class":"facility"}]},{"description":"OMNIPAQUE 300MG/ML","code_information":[{"code":"7991","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.36,"discounted_cash":3.18,"setting":"both","billing_class":"facility"}]},{"description":"NIRMATRELVIR PAXLOVI","code_information":[{"code":"7993","type":"CDM"},{"code":"637","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"MOLNUPIRAVIR LAGEVRI","code_information":[{"code":"7994","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"PAXLOVID RENAL 150/1","code_information":[{"code":"7995","type":"CDM"},{"code":"250","type":"RC"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"GADOBUTROL 0.1 ML","code_information":[{"code":"7996","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.56,"setting":"both","billing_class":"facility"}]},{"description":"GADAVIST 1 MMOL/ML 1","code_information":[{"code":"7997","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.56,"setting":"both","billing_class":"facility"}]},{"description":"DICLOFENAC TOPICAL G","code_information":[{"code":"7998","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":142.15,"discounted_cash":71.08,"setting":"both","billing_class":"facility"}]},{"description":"IODIXANOL VISIPAQUE","code_information":[{"code":"7999","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.77,"setting":"both","billing_class":"facility"}]},{"description":"MED/SURG 2 PRIVATE","code_information":[{"code":"8","type":"CDM"},{"code":"111","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1200.0,"setting":"both","billing_class":"facility"}]},{"description":"EPTINEZUMAB-JMR VYEP","code_information":[{"code":"8000","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3032","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":35.11,"discounted_cash":17.55,"setting":"both","billing_class":"facility"}]},{"description":"40% GLUCOSE GEL 3 ML","code_information":[{"code":"8001","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3032","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.35,"discounted_cash":2.17,"setting":"both","billing_class":"facility"}]},{"description":"KETAMINE 50 MG/5ML P","code_information":[{"code":"8002","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3032","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":11.25,"setting":"both","billing_class":"facility"}]},{"description":"IOHEXOL 240MG/ML","code_information":[{"code":"8003","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.26,"discounted_cash":571.13,"setting":"both","billing_class":"facility"}]},{"description":"BELANTAMAB MAFODOTIN","code_information":[{"code":"8004","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9037","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.56,"discounted_cash":47.28,"setting":"both","billing_class":"facility"}]},{"description":"TIXAGEV & CILGAV 600","code_information":[{"code":"8005","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0221","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility"}]},{"description":"EPINEPHRINE NSL 0.1","code_information":[{"code":"8006","type":"CDM"},{"code":"250","type":"RC"},{"code":"Q0221","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.2,"discounted_cash":25.1,"setting":"both","billing_class":"facility"}]},{"description":"EFGARTIGIMOD 400 MG","code_information":[{"code":"8007","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9332","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.76,"discounted_cash":31.88,"setting":"both","billing_class":"facility"}]},{"description":"NIVOLUMAB-RELATLIMAB","code_information":[{"code":"8008","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9298","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":366.75,"discounted_cash":183.38,"setting":"both","billing_class":"facility"}]},{"description":"KETAMINE SYRINGE 50","code_information":[{"code":"8009","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0896","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"INFLIXIMAB-ABDA 100","code_information":[{"code":"8010","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5104","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":215.05,"discounted_cash":107.53,"setting":"both","billing_class":"facility"}]},{"description":"CARFILZOMIB 30 MG J","code_information":[{"code":"8014","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9047","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.39,"discounted_cash":75.69,"setting":"both","billing_class":"facility"}]},{"description":"TRASTUZUMAB 150 MG J","code_information":[{"code":"8015","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9355","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":402.57,"discounted_cash":201.28,"setting":"both","billing_class":"facility"}]},{"description":"PEGFILGRASTIM ONPRO6","code_information":[{"code":"8016","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":14630.75,"discounted_cash":7315.38,"setting":"both","billing_class":"facility"}]},{"description":"SMART EZ PUMP","code_information":[{"code":"8017","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4305","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.4,"discounted_cash":15.2,"setting":"both","billing_class":"facility"}]},{"description":"NON-FORMULARY MED","code_information":[{"code":"8019","type":"CDM"},{"code":"999","type":"RC"},{"code":"A4305","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":6.64,"discounted_cash":3.32,"setting":"both","billing_class":"facility"}]},{"description":"RX MESSAGE FOR EMAR","code_information":[{"code":"8021","type":"CDM"},{"code":"999","type":"RC"},{"code":"A4305","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.89,"discounted_cash":0.45,"setting":"both","billing_class":"facility"}]},{"description":"PROTHROMBIN TIME INR","code_information":[{"code":"8023","type":"CDM"},{"code":"300","type":"RC"},{"code":"85610","type":"CPT"},{"code":"669","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.65,"discounted_cash":18.32,"setting":"both","billing_class":"facility"}]},{"description":"OUTPT E&M PT LEVEL I","code_information":[{"code":"8024","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"669","type":"LOCAL"}],"standard_charges":[{"gross_charge":316.69,"discounted_cash":158.34,"setting":"both","billing_class":"facility"}]},{"description":"EST PATIENT LEVEL I","code_information":[{"code":"8025","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":168.25,"discounted_cash":84.13,"setting":"both","billing_class":"facility"}]},{"description":"EST PATIENT LEVEL II","code_information":[{"code":"8026","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":211.98,"discounted_cash":105.99,"setting":"both","billing_class":"facility"}]},{"description":"EST PATIENT LEVELIII","code_information":[{"code":"8027","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":231.83,"discounted_cash":115.92,"setting":"both","billing_class":"facility"}]},{"description":"EST PATIENT LEVEL IV","code_information":[{"code":"8028","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":234.29,"discounted_cash":117.14,"setting":"both","billing_class":"facility"}]},{"description":"BLAD INSTIL W CHEMO","code_information":[{"code":"8030","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.75,"discounted_cash":410.88,"setting":"both","billing_class":"facility"}]},{"description":"VENIPUNCTURE","code_information":[{"code":"8031","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.65,"discounted_cash":15.32,"setting":"both","billing_class":"facility"}]},{"description":"TRANSFUSION BLD/COMP","code_information":[{"code":"8032","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":935.38,"discounted_cash":467.69,"setting":"both","billing_class":"facility"}]},{"description":"INSERT PICC> 5 YRS","code_information":[{"code":"8033","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":1901.75,"discounted_cash":950.88,"setting":"both","billing_class":"facility"}]},{"description":"COLLECT BLOOD IVAD","code_information":[{"code":"8034","type":"CDM"},{"code":"761","type":"RC"},{"code":"36591","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.8,"discounted_cash":118.9,"setting":"both","billing_class":"facility"}]},{"description":"DECLOT THROM IMP DEV","code_information":[{"code":"8035","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":472.7,"discounted_cash":236.35,"setting":"both","billing_class":"facility"}]},{"description":"BLD COUNT HEMOGLOBIN","code_information":[{"code":"8036","type":"CDM"},{"code":"300","type":"RC"},{"code":"85018","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.05,"discounted_cash":16.52,"setting":"both","billing_class":"facility"}]},{"description":"IMMUN ADMIN 1ST VACC","code_information":[{"code":"8037","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":99.43,"discounted_cash":49.72,"setting":"both","billing_class":"facility"}]},{"description":"IV INF HYDR INTL HR","code_information":[{"code":"8038","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":294.1,"discounted_cash":147.05,"setting":"both","billing_class":"facility"}]},{"description":"IV INF HYDR ADDL HR","code_information":[{"code":"8039","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.3,"discounted_cash":26.65,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX 1ST HR","code_information":[{"code":"8040","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":294.1,"discounted_cash":147.05,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX ADDL HR","code_information":[{"code":"8041","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility"}]},{"description":"IV INF TX/DX SEQ 1HR","code_information":[{"code":"8042","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":166.1,"discounted_cash":83.05,"setting":"both","billing_class":"facility"}]},{"description":"INJ IM/SQ","code_information":[{"code":"8043","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":53.88,"setting":"both","billing_class":"facility"}]},{"description":"INJ/IV INT/SGL SUBS","code_information":[{"code":"8044","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":125.5,"discounted_cash":62.75,"setting":"both","billing_class":"facility"}]},{"description":"INJ/IV ADD/SEQ SUBS","code_information":[{"code":"8045","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":158.5,"discounted_cash":79.25,"setting":"both","billing_class":"facility"}]},{"description":"INJ/IV SAME DRUG ADD","code_information":[{"code":"8046","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":196.5,"discounted_cash":98.25,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO ANTI-NEO SQ/IM","code_information":[{"code":"8047","type":"CDM"},{"code":"331","type":"RC"},{"code":"96401","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":499.51,"discounted_cash":249.75,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO ADMIN IVP SGL","code_information":[{"code":"8048","type":"CDM"},{"code":"331","type":"RC"},{"code":"96409","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":507.92,"discounted_cash":253.96,"setting":"both","billing_class":"facility"}]},{"description":"INSERT MIDLINE CATH","code_information":[{"code":"8049","type":"CDM"},{"code":"761","type":"RC"},{"code":"36410","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.65,"discounted_cash":58.33,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO IV INF 1ST HR","code_information":[{"code":"8050","type":"CDM"},{"code":"335","type":"RC"},{"code":"96413","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":1222.28,"discounted_cash":611.14,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO IV INF ADDL HR","code_information":[{"code":"8051","type":"CDM"},{"code":"335","type":"RC"},{"code":"96415","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":506.67,"discounted_cash":253.34,"setting":"both","billing_class":"facility"}]},{"description":"CHEMO IVINF ADDL SEQ","code_information":[{"code":"8052","type":"CDM"},{"code":"335","type":"RC"},{"code":"96417","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":412.88,"discounted_cash":206.44,"setting":"both","billing_class":"facility"}]},{"description":"PORT/CATH/PICC FLUSH","code_information":[{"code":"8053","type":"CDM"},{"code":"761","type":"RC"},{"code":"96523","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":198.35,"discounted_cash":99.17,"setting":"both","billing_class":"facility"}]},{"description":"PHLEBOTOMY THER SPX","code_information":[{"code":"8054","type":"CDM"},{"code":"940","type":"RC"},{"code":"99195","type":"CPT"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":164.85,"discounted_cash":82.42,"setting":"both","billing_class":"facility"}]},{"description":"CASIRIVI IMDEVI ADMI","code_information":[{"code":"8056","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0243","type":"HCPCS"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":1132.31,"discounted_cash":566.15,"setting":"both","billing_class":"facility"}]},{"description":"SOTROVIMAB INFUSION","code_information":[{"code":"8057","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0247","type":"HCPCS"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":1132.31,"discounted_cash":566.15,"setting":"both","billing_class":"facility"}]},{"description":"BAMLANIVIMAB ETESEVI","code_information":[{"code":"8065","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0245","type":"HCPCS"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":1132.31,"discounted_cash":566.15,"setting":"both","billing_class":"facility"}]},{"description":"IV ADMIN TOCILIZ 1ST","code_information":[{"code":"8066","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0249","type":"HCPCS"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":1573.51,"discounted_cash":786.75,"setting":"both","billing_class":"facility"}]},{"description":"IV ADMIN TOCILIZ 2ND","code_information":[{"code":"8067","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0250","type":"HCPCS"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":1573.51,"discounted_cash":786.75,"setting":"both","billing_class":"facility"}]},{"description":"TIXAGEV CILGAV INJ","code_information":[{"code":"8069","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0220","type":"HCPCS"},{"code":"620","type":"LOCAL"}],"standard_charges":[{"gross_charge":441.51,"discounted_cash":220.75,"setting":"both","billing_class":"facility"}]},{"description":"INSERT FOL CATH SIMP","code_information":[{"code":"8070","type":"CDM"},{"code":"761","type":"RC"},{"code":"SURG","type":"HCPCS"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":363.4,"discounted_cash":181.7,"setting":"both","billing_class":"facility"}]},{"description":"BEBTELOVIMAB INJ","code_information":[{"code":"8071","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0222","type":"HCPCS"},{"code":"698","type":"LOCAL"}],"standard_charges":[{"gross_charge":1285.45,"discounted_cash":642.73,"setting":"both","billing_class":"facility"}]},{"description":"IV LIDO 2GM/D5 500ML","code_information":[{"code":"8073","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2002","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.02,"setting":"both","billing_class":"facility"}]},{"description":"IV MANN 20% 500ML","code_information":[{"code":"8074","type":"CDM"},{"code":"258","type":"RC"},{"code":"J2002","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":168.5,"discounted_cash":84.25,"setting":"both","billing_class":"facility"}]},{"description":"IV AMINO AC 10% 500","code_information":[{"code":"8076","type":"CDM"},{"code":"258","type":"RC"},{"code":"J2002","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.9,"discounted_cash":38.95,"setting":"both","billing_class":"facility"}]},{"description":"IV AMINO AC 8.5/500","code_information":[{"code":"8077","type":"CDM"},{"code":"258","type":"RC"},{"code":"J2002","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IV D10W 1000ML","code_information":[{"code":"8079","type":"CDM"},{"code":"258","type":"RC"},{"code":"J2002","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility"}]},{"description":"IV D10W 500ML","code_information":[{"code":"8080","type":"CDM"},{"code":"258","type":"RC"},{"code":"J2002","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility"}]},{"description":"IV D20W 500ML","code_information":[{"code":"8081","type":"CDM"},{"code":"258","type":"RC"},{"code":"J2002","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IV D5/0.2NS 1000ML","code_information":[{"code":"8082","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IV D5/0.2NS 500ML","code_information":[{"code":"8083","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IV D5/0.45NS 1000ML","code_information":[{"code":"8084","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.85,"discounted_cash":15.93,"setting":"both","billing_class":"facility"}]},{"description":"IV D5/0.45NS 500ML","code_information":[{"code":"8085","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IV D5/LR 1000ML","code_information":[{"code":"8086","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IV D5/LR 500ML","code_information":[{"code":"8087","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.4,"discounted_cash":16.7,"setting":"both","billing_class":"facility"}]},{"description":"IV D5/NS 1000ML","code_information":[{"code":"8088","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.9,"discounted_cash":15.95,"setting":"both","billing_class":"facility"}]},{"description":"IV D5/NS 500ML","code_information":[{"code":"8089","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IV D5W 1000ML","code_information":[{"code":"8091","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.9,"discounted_cash":15.95,"setting":"both","billing_class":"facility"}]},{"description":"IV D5W 100ML IVPB","code_information":[{"code":"8092","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.85,"discounted_cash":15.93,"setting":"both","billing_class":"facility"}]},{"description":"IV D5W 250ML","code_information":[{"code":"8093","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.85,"discounted_cash":15.93,"setting":"both","billing_class":"facility"}]},{"description":"IV D5W 500ML","code_information":[{"code":"8094","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.9,"discounted_cash":15.95,"setting":"both","billing_class":"facility"}]},{"description":"IV D5W 50ML IVPB","code_information":[{"code":"8095","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.2,"discounted_cash":16.1,"setting":"both","billing_class":"facility"}]},{"description":"IV D70W 500ML","code_information":[{"code":"8097","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.85,"discounted_cash":32.92,"setting":"both","billing_class":"facility"}]},{"description":"IV DEXTRAN 40/D5 500","code_information":[{"code":"8098","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7100","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":101.55,"discounted_cash":50.77,"setting":"both","billing_class":"facility"}]},{"description":"IV HETASTAR 6% 500ML","code_information":[{"code":"8101","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7100","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.3,"discounted_cash":38.65,"setting":"both","billing_class":"facility"}]},{"description":"IV LACT RINGERS 1000","code_information":[{"code":"8102","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"IV LACT RINGERS 500M","code_information":[{"code":"8103","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.4,"discounted_cash":16.7,"setting":"both","billing_class":"facility"}]},{"description":"IV NACL 0.45% 1000ML","code_information":[{"code":"8106","type":"CDM"},{"code":"250","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.85,"discounted_cash":15.93,"setting":"both","billing_class":"facility"}]},{"description":"IV NACL 0.45% 500ML","code_information":[{"code":"8107","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.6,"discounted_cash":16.3,"setting":"both","billing_class":"facility"}]},{"description":"IV NACL 0.9% 1000ML","code_information":[{"code":"8108","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"IV NACL 0.9% 100ML","code_information":[{"code":"8109","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"IV NACL 0.9% 250ML","code_information":[{"code":"8110","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.65,"discounted_cash":16.32,"setting":"both","billing_class":"facility"}]},{"description":"IV NACL 0.9% 500ML","code_information":[{"code":"8111","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":16.35,"setting":"both","billing_class":"facility"}]},{"description":"IV NACL 0.9% 50ML","code_information":[{"code":"8112","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.65,"discounted_cash":16.32,"setting":"both","billing_class":"facility"}]},{"description":"IV NACL 3% 500ML","code_information":[{"code":"8113","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.8,"discounted_cash":16.4,"setting":"both","billing_class":"facility"}]},{"description":"IV WATER ST 1000ML I","code_information":[{"code":"8115","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility"}]},{"description":"IV LIPID 20% 500ML","code_information":[{"code":"8118","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.8,"discounted_cash":43.4,"setting":"both","billing_class":"facility"}]},{"description":"ALBUMIN 25% 50 ML","code_information":[{"code":"8127","type":"CDM"},{"code":"258","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":169.07,"discounted_cash":84.53,"setting":"both","billing_class":"facility"}]},{"description":"FLUCONAZ 100MG/50ML","code_information":[{"code":"8128","type":"CDM"},{"code":"258","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.45,"discounted_cash":16.23,"setting":"both","billing_class":"facility"}]},{"description":"IV MAG SO4 (PMX) SOL","code_information":[{"code":"8130","type":"CDM"},{"code":"258","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.8,"discounted_cash":0.4,"setting":"both","billing_class":"facility"}]},{"description":"IV D40W  500ML","code_information":[{"code":"8138","type":"CDM"},{"code":"258","type":"RC"},{"code":"P9041","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":124.05,"discounted_cash":62.02,"setting":"both","billing_class":"facility"}]},{"description":"IV D50W 500ML","code_information":[{"code":"8140","type":"CDM"},{"code":"258","type":"RC"},{"code":"P9041","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.9,"discounted_cash":32.45,"setting":"both","billing_class":"facility"}]},{"description":"IV D5 .45 10KCL","code_information":[{"code":"8145","type":"CDM"},{"code":"258","type":"RC"},{"code":"P9041","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.95,"discounted_cash":15.97,"setting":"both","billing_class":"facility"}]},{"description":"IV D5.09  20KCL","code_information":[{"code":"8146","type":"CDM"},{"code":"258","type":"RC"},{"code":"P9041","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.95,"discounted_cash":15.97,"setting":"both","billing_class":"facility"}]},{"description":"IV D5 .45 40KCL","code_information":[{"code":"8150","type":"CDM"},{"code":"258","type":"RC"},{"code":"P9041","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IV D5 .45 20KCL 1L","code_information":[{"code":"8153","type":"CDM"},{"code":"258","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.9,"discounted_cash":15.95,"setting":"both","billing_class":"facility"}]},{"description":"NTG 5MG (50MG D5 250","code_information":[{"code":"8155","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2305","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.05,"discounted_cash":4.03,"setting":"both","billing_class":"facility"}]},{"description":"IV D5 0.45 NACL 1000","code_information":[{"code":"8161","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":18.38,"setting":"both","billing_class":"facility"}]},{"description":"IV D5 100ML ADV DEX","code_information":[{"code":"8164","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IV DEX 5% 1000ML","code_information":[{"code":"8165","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":18.38,"setting":"both","billing_class":"facility"}]},{"description":"IV DEX 5% 250ML","code_information":[{"code":"8167","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":18.38,"setting":"both","billing_class":"facility"}]},{"description":"IV DEX 5% 50ML","code_information":[{"code":"8169","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":18.38,"setting":"both","billing_class":"facility"}]},{"description":"IV DEX 5% INJ 500ML","code_information":[{"code":"8170","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":18.38,"setting":"both","billing_class":"facility"}]},{"description":"IV NACL 0.9 MB+ 100","code_information":[{"code":"8175","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.65,"discounted_cash":16.32,"setting":"both","billing_class":"facility"}]},{"description":"IVPB NS MB+ 50ML","code_information":[{"code":"8187","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IVPB KCL20MEQ/100ML","code_information":[{"code":"8188","type":"CDM"},{"code":"258","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":3.15,"discounted_cash":1.57,"setting":"both","billing_class":"facility"}]},{"description":"IVPB CEFAZOLIN 1GM","code_information":[{"code":"8190","type":"CDM"},{"code":"258","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.3,"discounted_cash":8.15,"setting":"both","billing_class":"facility"}]},{"description":"IVPB CEFOTAX NA 1GM","code_information":[{"code":"8192","type":"CDM"},{"code":"258","type":"RC"},{"code":"J0698","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":4.13,"setting":"both","billing_class":"facility"}]},{"description":"IVPB CEFOXITIN  2GM","code_information":[{"code":"8195","type":"CDM"},{"code":"258","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":12.13,"setting":"both","billing_class":"facility"}]},{"description":"IVPB AMPICIL SUL 3GM","code_information":[{"code":"8204","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.37,"discounted_cash":15.69,"setting":"both","billing_class":"facility"}]},{"description":"IVPB AMPICIL SUL 1.5","code_information":[{"code":"8205","type":"CDM"},{"code":"258","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.45,"discounted_cash":14.72,"setting":"both","billing_class":"facility"}]},{"description":"IV D5W/DOPAMINE 800M","code_information":[{"code":"8211","type":"CDM"},{"code":"258","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":2.13,"setting":"both","billing_class":"facility"}]},{"description":"IVDOBUT/D5 250/250ML","code_information":[{"code":"8219","type":"CDM"},{"code":"258","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.5,"discounted_cash":41.75,"setting":"both","billing_class":"facility"}]},{"description":"IV HEP 25000 D5 500","code_information":[{"code":"8220","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.64,"setting":"both","billing_class":"facility"}]},{"description":"METRONID 10MG(500MG)","code_information":[{"code":"8224","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.1,"discounted_cash":0.05,"setting":"both","billing_class":"facility"}]},{"description":"IVPB NACL .9% 100ML","code_information":[{"code":"8225","type":"CDM"},{"code":"258","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.9,"discounted_cash":15.95,"setting":"both","billing_class":"facility"}]},{"description":"IV D5W 100ML","code_information":[{"code":"8228","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":18.38,"setting":"both","billing_class":"facility"}]},{"description":"IV D5LR 20KCL 1000ML","code_information":[{"code":"8237","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IV D5.45NS 30KCL 1L","code_information":[{"code":"8238","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IVPB GENTAMI 100MG","code_information":[{"code":"8246","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.04,"discounted_cash":8.02,"setting":"both","billing_class":"facility"}]},{"description":"IV MOXIFLOX 400MG PM","code_information":[{"code":"8253","type":"CDM"},{"code":"258","type":"RC"},{"code":"J2280","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":41.1,"discounted_cash":20.55,"setting":"both","billing_class":"facility"}]},{"description":"IV LIPID 20% 250ML","code_information":[{"code":"8260","type":"CDM"},{"code":"258","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":142.7,"discounted_cash":71.35,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAM 300MG(900MG)","code_information":[{"code":"8262","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.94,"discounted_cash":8.97,"setting":"both","billing_class":"facility"}]},{"description":"IVPB NACL 50 PAB","code_information":[{"code":"8270","type":"CDM"},{"code":"258","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IVPB GENTAM 120MG","code_information":[{"code":"8271","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.3,"discounted_cash":8.15,"setting":"both","billing_class":"facility"}]},{"description":"IV DEX 10% 250ML","code_information":[{"code":"8273","type":"CDM"},{"code":"258","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":15.15,"setting":"both","billing_class":"facility"}]},{"description":"IV DEXTROS 30% 500ML","code_information":[{"code":"8277","type":"CDM"},{"code":"258","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":108.2,"discounted_cash":54.1,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAM 300MG(600MG)","code_information":[{"code":"8281","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.04,"discounted_cash":11.02,"setting":"both","billing_class":"facility"}]},{"description":"IV D5 NS 40KCL 1000","code_information":[{"code":"8283","type":"CDM"},{"code":"258","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IV NACL 0.9 150ML","code_information":[{"code":"8292","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.65,"discounted_cash":16.32,"setting":"both","billing_class":"facility"}]},{"description":"IVPB CEFTRIAX 1GM/50","code_information":[{"code":"8293","type":"CDM"},{"code":"258","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility"}]},{"description":"IV LINEZOLID 600/300","code_information":[{"code":"8303","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":69.7,"discounted_cash":34.85,"setting":"both","billing_class":"facility"}]},{"description":"IV NS KCL 20MEQ 1000","code_information":[{"code":"8305","type":"CDM"},{"code":"258","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.85,"discounted_cash":15.93,"setting":"both","billing_class":"facility"}]},{"description":"IV NS KCL 40MEQ 1000","code_information":[{"code":"8314","type":"CDM"},{"code":"258","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.9,"discounted_cash":15.95,"setting":"both","billing_class":"facility"}]},{"description":"IV NACL .45 20KCL 1L","code_information":[{"code":"8316","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.65,"discounted_cash":16.32,"setting":"both","billing_class":"facility"}]},{"description":"IV MANN 20% 250ML","code_information":[{"code":"8324","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility"}]},{"description":"IV CLINI 5/25 1L","code_information":[{"code":"8327","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.05,"discounted_cash":69.03,"setting":"both","billing_class":"facility"}]},{"description":"IV CLINI 4.25/5 1L","code_information":[{"code":"8328","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.45,"discounted_cash":60.23,"setting":"both","billing_class":"facility"}]},{"description":"IV ESMOL 10MG(2500)","code_information":[{"code":"8342","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":2.0,"setting":"both","billing_class":"facility"}]},{"description":"IV D5 0.9%  NACL 1L","code_information":[{"code":"8344","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":18.38,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAM 300MG","code_information":[{"code":"8350","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.6,"discounted_cash":16.3,"setting":"both","billing_class":"facility"}]},{"description":"IV DEXTROSE 10% 1000","code_information":[{"code":"8359","type":"CDM"},{"code":"258","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":18.38,"setting":"both","billing_class":"facility"}]},{"description":"IVPB CEFAZ 1GM/50ML","code_information":[{"code":"8366","type":"CDM"},{"code":"258","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.35,"discounted_cash":9.18,"setting":"both","billing_class":"facility"}]},{"description":"IVPB VANCOMY 1GM/200","code_information":[{"code":"8369","type":"CDM"},{"code":"258","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":54.65,"discounted_cash":27.32,"setting":"both","billing_class":"facility"}]},{"description":"IV CLINI E 4.25/5 1L","code_information":[{"code":"8373","type":"CDM"},{"code":"258","type":"RC"},{"code":"J3246","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":132.35,"discounted_cash":66.17,"setting":"both","billing_class":"facility"}]},{"description":"IV CLINI E 5/25 1L","code_information":[{"code":"8374","type":"CDM"},{"code":"258","type":"RC"},{"code":"J3246","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":140.95,"discounted_cash":70.47,"setting":"both","billing_class":"facility"}]},{"description":"IVPB MAGNES1GM/100ML","code_information":[{"code":"8391","type":"CDM"},{"code":"258","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.9,"discounted_cash":7.95,"setting":"both","billing_class":"facility"}]},{"description":"IV AMIN AC 15% 500ML","code_information":[{"code":"8399","type":"CDM"},{"code":"258","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":293.95,"discounted_cash":146.97,"setting":"both","billing_class":"facility"}]},{"description":"IVPB MAG SUL 2GM/50M","code_information":[{"code":"8412","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":17.94,"discounted_cash":8.97,"setting":"both","billing_class":"facility"}]},{"description":"CEFAZ 500MG (2GM/50M","code_information":[{"code":"8415","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0689","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":7.89,"discounted_cash":3.94,"setting":"both","billing_class":"facility"}]},{"description":"IVPB GENT 80MG/50ML","code_information":[{"code":"8416","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.19,"discounted_cash":16.09,"setting":"both","billing_class":"facility"}]},{"description":"IV DILT 1MG/ML 100ML","code_information":[{"code":"8418","type":"CDM"},{"code":"258","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.05,"discounted_cash":37.52,"setting":"both","billing_class":"facility"}]},{"description":"IV OB EPIDURAL 100ML","code_information":[{"code":"8419","type":"CDM"},{"code":"258","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":75.25,"discounted_cash":37.63,"setting":"both","billing_class":"facility"}]},{"description":"IV FENT 10MCG/ML 100","code_information":[{"code":"8420","type":"CDM"},{"code":"258","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.9,"discounted_cash":4.95,"setting":"both","billing_class":"facility"}]},{"description":"IN INSULIN 1U/ML 100","code_information":[{"code":"8421","type":"CDM"},{"code":"258","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.45,"discounted_cash":43.23,"setting":"both","billing_class":"facility"}]},{"description":"IV LORAZ 1MG/ML 100","code_information":[{"code":"8422","type":"CDM"},{"code":"258","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility"}]},{"description":"METRON 10MG(250MG)","code_information":[{"code":"8423","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.1,"discounted_cash":0.05,"setting":"both","billing_class":"facility"}]},{"description":"IV MIDAZ 1MG/ML 100","code_information":[{"code":"8424","type":"CDM"},{"code":"258","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility"}]},{"description":"IV OXYTOC 20U/1000ML","code_information":[{"code":"8425","type":"CDM"},{"code":"258","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.95,"discounted_cash":43.98,"setting":"both","billing_class":"facility"}]},{"description":"IV AMIOD 150MG 100ML","code_information":[{"code":"8426","type":"CDM"},{"code":"258","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.01,"discounted_cash":12.51,"setting":"both","billing_class":"facility"}]},{"description":"AMIODARONE 30MG(360)","code_information":[{"code":"8427","type":"CDM"},{"code":"258","type":"RC"},{"code":"J0283","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.79,"discounted_cash":5.89,"setting":"both","billing_class":"facility"}]},{"description":"IV D5W EXCEL 250ML","code_information":[{"code":"8428","type":"CDM"},{"code":"258","type":"RC"},{"code":"J0283","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":15.9,"setting":"both","billing_class":"facility"}]},{"description":"IV HEP 2U/ML NS 1000","code_information":[{"code":"8429","type":"CDM"},{"code":"258","type":"RC"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.9,"discounted_cash":7.95,"setting":"both","billing_class":"facility"}]},{"description":"IVPB NICARD 20MG/200","code_information":[{"code":"8430","type":"CDM"},{"code":"258","type":"RC"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":262.35,"discounted_cash":131.18,"setting":"both","billing_class":"facility"}]},{"description":"IV NS EXCEL 500ML","code_information":[{"code":"8431","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.85,"discounted_cash":15.93,"setting":"both","billing_class":"facility"}]},{"description":"IV NS EXCEL 250CC","code_information":[{"code":"8433","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.65,"discounted_cash":16.32,"setting":"both","billing_class":"facility"}]},{"description":"ZOLEDRONIC ACID PMXG","code_information":[{"code":"8434","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":1357.25,"discounted_cash":678.63,"setting":"both","billing_class":"facility"}]},{"description":"IV DEX 10% 500ML","code_information":[{"code":"8435","type":"CDM"},{"code":"258","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":18.38,"setting":"both","billing_class":"facility"}]},{"description":"IV D5W 0.2% NACL 500","code_information":[{"code":"8436","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":18.38,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAMYCIN 300MG/50","code_information":[{"code":"8437","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":32.08,"discounted_cash":16.04,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAM 300MG(600MG)","code_information":[{"code":"8438","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":19.01,"discounted_cash":9.51,"setting":"both","billing_class":"facility"}]},{"description":"CLINDAMYCIN 900MG/50","code_information":[{"code":"8439","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":64.45,"discounted_cash":32.23,"setting":"both","billing_class":"facility"}]},{"description":"VANCOMYCIN 1250MG250","code_information":[{"code":"8440","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":25.57,"discounted_cash":12.79,"setting":"both","billing_class":"facility"}]},{"description":"TIROFIBAN 12.5MG J","code_information":[{"code":"8447","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3246","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":28.34,"discounted_cash":14.17,"setting":"both","billing_class":"facility"}]},{"description":"TIROFIBAN 3.75MG J","code_information":[{"code":"8448","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3246","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":5.87,"setting":"both","billing_class":"facility"}]},{"description":"BIVALIRUDIN 250MG J","code_information":[{"code":"8449","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":1243.48,"discounted_cash":621.74,"setting":"both","billing_class":"facility"}]},{"description":"CEFAZOLIN 3GM/100ML","code_information":[{"code":"8450","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.43,"discounted_cash":2.71,"setting":"both","billing_class":"facility"}]},{"description":"TIROFIBAN 5MG/100ML","code_information":[{"code":"8451","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3246","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":34.54,"discounted_cash":17.27,"setting":"both","billing_class":"facility"}]},{"description":"PIP/TAZ 3.375GMPMX50","code_information":[{"code":"8452","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.26,"discounted_cash":15.63,"setting":"both","billing_class":"facility"}]},{"description":"TRI CHLOR","code_information":[{"code":"8453","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"699","type":"LOCAL"}],"standard_charges":[{"gross_charge":194.75,"discounted_cash":97.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP SILICONE SHEETNG","code_information":[{"code":"8455","type":"CDM"},{"code":"278","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":128.12,"discounted_cash":64.06,"setting":"both","billing_class":"facility"}]},{"description":"GRFT KERECS PER SQCM","code_information":[{"code":"8456","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":139.66,"discounted_cash":69.83,"setting":"both","billing_class":"facility"}]},{"description":"GFT KERECIS PER SQCM","code_information":[{"code":"8457","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":163.33,"discounted_cash":81.67,"setting":"both","billing_class":"facility"}]},{"description":"GFT KERECIS 1SQ (49)","code_information":[{"code":"8458","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":113.83,"discounted_cash":56.91,"setting":"both","billing_class":"facility"}]},{"description":"GFT KERECIS 1SQ (19)","code_information":[{"code":"8459","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.53,"discounted_cash":86.77,"setting":"both","billing_class":"facility"}]},{"description":"GFT KERECIS 1SQ (11)","code_information":[{"code":"8460","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":216.58,"discounted_cash":108.29,"setting":"both","billing_class":"facility"}]},{"description":"GFT KERECS SQCM(140)","code_information":[{"code":"8461","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":160.62,"discounted_cash":80.31,"setting":"both","billing_class":"facility"}]},{"description":"GRAFT KERECIS 1SQCM","code_information":[{"code":"8462","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":396.32,"discounted_cash":198.16,"setting":"both","billing_class":"facility"}]},{"description":"GRFT KEREC1SQCM(252)","code_information":[{"code":"8463","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":97.12,"discounted_cash":48.56,"setting":"both","billing_class":"facility"}]},{"description":"DEV FX BCM DST BICEP","code_information":[{"code":"8464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2423.56,"discounted_cash":1211.78,"setting":"both","billing_class":"facility"}]},{"description":"GFT ACUSEAL 45CM 4-6","code_information":[{"code":"8465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3005.11,"discounted_cash":1502.56,"setting":"both","billing_class":"facility"}]},{"description":"GFT BONE 1 FCTR 2.5C","code_information":[{"code":"8466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2906.88,"discounted_cash":1453.44,"setting":"both","billing_class":"facility"}]},{"description":"GFT BONE ALGRF FRZN","code_information":[{"code":"8467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3201.51,"discounted_cash":1600.76,"setting":"both","billing_class":"facility"}]},{"description":"GFT BONE ACL GRACLIS","code_information":[{"code":"8468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2505.86,"discounted_cash":1252.93,"setting":"both","billing_class":"facility"}]},{"description":"GFT HMDIAL 53CM 7.4M","code_information":[{"code":"8469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2205.21,"discounted_cash":1102.61,"setting":"both","billing_class":"facility"}]},{"description":"GFT PRIMTR 1SQ(36SQ)","code_information":[{"code":"8470","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4110","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2406.75,"discounted_cash":1203.38,"setting":"both","billing_class":"facility"}]},{"description":"GFT PROCOL 6MMX30CM","code_information":[{"code":"8471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2706.34,"discounted_cash":1353.17,"setting":"both","billing_class":"facility"}]},{"description":"GRAFT PROPATEN ACUSE","code_information":[{"code":"8472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3005.11,"discounted_cash":1502.56,"setting":"both","billing_class":"facility"}]},{"description":"GRAFT ST TIS SMTNDNS","code_information":[{"code":"8473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3005.11,"discounted_cash":1502.56,"setting":"both","billing_class":"facility"}]},{"description":"ANCHR BNE TGHTRPE XP","code_information":[{"code":"8474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2996.85,"discounted_cash":1498.42,"setting":"both","billing_class":"facility"}]},{"description":"PLTE OMNI FIX 42112","code_information":[{"code":"8475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2469.65,"discounted_cash":1234.83,"setting":"both","billing_class":"facility"}]},{"description":"PLTE OMNI FIX 42116","code_information":[{"code":"8476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2565.89,"discounted_cash":1282.94,"setting":"both","billing_class":"facility"}]},{"description":"STAPLE BONE 14X10MM","code_information":[{"code":"8477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2459.77,"discounted_cash":1229.88,"setting":"both","billing_class":"facility"}]},{"description":"ANCHOR SUTURE 4.75MM","code_information":[{"code":"8478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2565.89,"discounted_cash":1282.94,"setting":"both","billing_class":"facility"}]},{"description":"FIX SYS FACHILLES SP","code_information":[{"code":"8479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2280.35,"discounted_cash":1140.17,"setting":"both","billing_class":"facility"}]},{"description":"GFT KERECIS 1SQ(24)","code_information":[{"code":"8480","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":203.67,"discounted_cash":101.83,"setting":"both","billing_class":"facility"}]},{"description":"WASHER G23 7X3.5MM","code_information":[{"code":"8481","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.1,"discounted_cash":112.05,"setting":"both","billing_class":"facility"}]},{"description":"GFT KERCIS SQCM(101)","code_information":[{"code":"8482","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":89.59,"discounted_cash":44.8,"setting":"both","billing_class":"facility"}]},{"description":"GFT KERCIS SQCM(250)","code_information":[{"code":"8483","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":679.11,"discounted_cash":339.56,"setting":"both","billing_class":"facility"}]},{"description":"GFT KERESIS 1SQ(21)","code_information":[{"code":"8484","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":180.81,"discounted_cash":90.41,"setting":"both","billing_class":"facility"}]},{"description":"WSHR/NUT/CAP G23","code_information":[{"code":"8485","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":224.1,"discounted_cash":112.05,"setting":"both","billing_class":"facility"}]},{"description":"GFT KERECS 1SQCM(21)","code_information":[{"code":"8486","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":198.85,"discounted_cash":99.42,"setting":"both","billing_class":"facility"}]},{"description":"GRAFT BONE CNLS 15.0","code_information":[{"code":"8487","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":730.98,"discounted_cash":365.49,"setting":"both","billing_class":"facility"}]},{"description":"GFT ACHILLIES WO BNE","code_information":[{"code":"8488","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3102.34,"discounted_cash":1551.17,"setting":"both","billing_class":"facility"}]},{"description":"IMP NEURO GEN RC G66","code_information":[{"code":"8489","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":36563.77,"discounted_cash":18281.88,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS","code_information":[{"code":"8490","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.21,"discounted_cash":147.6,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS G27","code_information":[{"code":"8491","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":508.03,"discounted_cash":254.01,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS G28","code_information":[{"code":"8492","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":677.37,"discounted_cash":338.69,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS G29","code_information":[{"code":"8493","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.71,"discounted_cash":423.36,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS G30","code_information":[{"code":"8494","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":924.25,"discounted_cash":462.13,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS G31","code_information":[{"code":"8495","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1108.48,"discounted_cash":554.24,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS G32","code_information":[{"code":"8496","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1231.58,"discounted_cash":615.79,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS G33","code_information":[{"code":"8497","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.57,"discounted_cash":692.78,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS G34","code_information":[{"code":"8498","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.49,"discounted_cash":769.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS G37","code_information":[{"code":"8499","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2419.44,"discounted_cash":1209.72,"setting":"both","billing_class":"facility"}]},{"description":"MED/SURG 1 PRIVATE","code_information":[{"code":"85","type":"CDM"},{"code":"111","type":"RC"},{"code":"92558","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1200.0,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS G38","code_information":[{"code":"8500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.77,"discounted_cash":1212.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS G39","code_information":[{"code":"8501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2694.11,"discounted_cash":1347.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G33","code_information":[{"code":"8502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.67,"discounted_cash":692.84,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G34","code_information":[{"code":"8503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.49,"discounted_cash":769.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G35","code_information":[{"code":"8504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.51,"discounted_cash":808.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G36","code_information":[{"code":"8505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1885.86,"discounted_cash":942.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G37","code_information":[{"code":"8506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.26,"discounted_cash":1077.63,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G38","code_information":[{"code":"8507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.66,"discounted_cash":1212.33,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G39","code_information":[{"code":"8508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2694.11,"discounted_cash":1347.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G41","code_information":[{"code":"8510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.64,"discounted_cash":2309.32,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G42","code_information":[{"code":"8511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5773.15,"discounted_cash":2886.57,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G43","code_information":[{"code":"8512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6927.88,"discounted_cash":3463.94,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G44","code_information":[{"code":"8513","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8082.5,"discounted_cash":4041.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G45","code_information":[{"code":"8514","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9237.17,"discounted_cash":4618.59,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G46","code_information":[{"code":"8515","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10391.85,"discounted_cash":5195.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G47","code_information":[{"code":"8516","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11546.47,"discounted_cash":5773.23,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G48","code_information":[{"code":"8517","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10584.28,"discounted_cash":5292.14,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN PUTTY G28","code_information":[{"code":"8518","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":677.26,"discounted_cash":338.63,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN PUTTY G31","code_information":[{"code":"8519","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1077.66,"discounted_cash":538.83,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN PUTTY G32","code_information":[{"code":"8520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1231.64,"discounted_cash":615.82,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN PUTTY G33","code_information":[{"code":"8521","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.57,"discounted_cash":692.78,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN PUTTY G34","code_information":[{"code":"8522","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.7,"discounted_cash":769.85,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN PUTTY G35","code_information":[{"code":"8523","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.51,"discounted_cash":808.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN PUTTY G36","code_information":[{"code":"8524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1885.86,"discounted_cash":942.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN PUTTY G37","code_information":[{"code":"8525","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.26,"discounted_cash":1077.63,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN PUTTY G38","code_information":[{"code":"8526","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.77,"discounted_cash":1212.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN PUTTY G39","code_information":[{"code":"8527","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2608.48,"discounted_cash":1304.24,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN PUTTY G40","code_information":[{"code":"8528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN PUTTY G41","code_information":[{"code":"8529","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.64,"discounted_cash":2309.32,"setting":"both","billing_class":"facility"}]},{"description":"IMP BREAST G38","code_information":[{"code":"8530","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.77,"discounted_cash":1212.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP BREAST G39","code_information":[{"code":"8531","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2694.11,"discounted_cash":1347.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP BREAST G40","code_information":[{"code":"8532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP BREAST G41","code_information":[{"code":"8533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.53,"discounted_cash":2309.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP BREAST G42","code_information":[{"code":"8534","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5773.15,"discounted_cash":2886.57,"setting":"both","billing_class":"facility"}]},{"description":"IMP BREAST G43","code_information":[{"code":"8535","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6927.88,"discounted_cash":3463.94,"setting":"both","billing_class":"facility"}]},{"description":"IMP BREAST G44","code_information":[{"code":"8536","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8082.5,"discounted_cash":4041.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G22","code_information":[{"code":"8537","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":228.59,"discounted_cash":114.3,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G23","code_information":[{"code":"8538","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":258.59,"discounted_cash":129.29,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G24","code_information":[{"code":"8539","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.63,"discounted_cash":147.81,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G25","code_information":[{"code":"8540","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.52,"discounted_cash":166.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G26","code_information":[{"code":"8541","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":369.51,"discounted_cash":184.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G27","code_information":[{"code":"8542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":508.03,"discounted_cash":254.01,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G28","code_information":[{"code":"8543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":682.39,"discounted_cash":341.19,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G29","code_information":[{"code":"8544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.71,"discounted_cash":423.36,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G30","code_information":[{"code":"8545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":923.68,"discounted_cash":461.84,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G31","code_information":[{"code":"8546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1077.66,"discounted_cash":538.83,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G32","code_information":[{"code":"8547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1231.64,"discounted_cash":615.82,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G33","code_information":[{"code":"8548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.57,"discounted_cash":692.78,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G34","code_information":[{"code":"8549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.39,"discounted_cash":769.7,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G35","code_information":[{"code":"8550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.51,"discounted_cash":808.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G36","code_information":[{"code":"8551","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1885.86,"discounted_cash":942.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G37","code_information":[{"code":"8552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.26,"discounted_cash":1077.63,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G38","code_information":[{"code":"8553","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.77,"discounted_cash":1212.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G39","code_information":[{"code":"8554","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2694.11,"discounted_cash":1347.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT BN G40","code_information":[{"code":"8555","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3445.78,"discounted_cash":1722.89,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT G42","code_information":[{"code":"8556","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2412.54,"discounted_cash":1206.27,"setting":"both","billing_class":"facility"}]},{"description":"IMP CEMENT G43","code_information":[{"code":"8557","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8062.02,"discounted_cash":4031.01,"setting":"both","billing_class":"facility"}]},{"description":"KIT KEPHRO W CEMENT","code_information":[{"code":"8558","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":7366.1,"discounted_cash":3683.05,"setting":"both","billing_class":"facility"}]},{"description":"NASAL PROPEL CONTOUR","code_information":[{"code":"8559","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2205.68,"discounted_cash":1102.84,"setting":"both","billing_class":"facility"}]},{"description":"IMP EAR TUBES G05","code_information":[{"code":"8560","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.14,"discounted_cash":23.07,"setting":"both","billing_class":"facility"}]},{"description":"IMP EAR TUBES G06","code_information":[{"code":"8561","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":51.52,"discounted_cash":25.76,"setting":"both","billing_class":"facility"}]},{"description":"IMP EAR TUBES G07","code_information":[{"code":"8562","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.35,"discounted_cash":30.18,"setting":"both","billing_class":"facility"}]},{"description":"IMP EAR TUBES G08","code_information":[{"code":"8563","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":68.87,"discounted_cash":34.44,"setting":"both","billing_class":"facility"}]},{"description":"IMP EAR TUBES G09","code_information":[{"code":"8564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.75,"discounted_cash":38.88,"setting":"both","billing_class":"facility"}]},{"description":"IMP EAR TUBES G10","code_information":[{"code":"8565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.26,"discounted_cash":43.13,"setting":"both","billing_class":"facility"}]},{"description":"IMP EAR TUBES G11","code_information":[{"code":"8566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.09,"discounted_cash":44.05,"setting":"both","billing_class":"facility"}]},{"description":"IMP EAR TUBES G12","code_information":[{"code":"8567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.19,"discounted_cash":48.09,"setting":"both","billing_class":"facility"}]},{"description":"IMP EAR TUBES G13","code_information":[{"code":"8568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.87,"discounted_cash":51.94,"setting":"both","billing_class":"facility"}]},{"description":"IMP ELBOW JNT G41","code_information":[{"code":"8569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5699.59,"discounted_cash":2849.8,"setting":"both","billing_class":"facility"}]},{"description":"IMP ELBOW JNT G42","code_information":[{"code":"8570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":7124.5,"discounted_cash":3562.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP EXFIX G40","code_information":[{"code":"8571","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G11","code_information":[{"code":"8573","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.09,"discounted_cash":44.05,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G12","code_information":[{"code":"8574","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.19,"discounted_cash":48.09,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G13","code_information":[{"code":"8575","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.87,"discounted_cash":51.94,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G14","code_information":[{"code":"8576","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.97,"discounted_cash":55.98,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G15","code_information":[{"code":"8577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.07,"discounted_cash":60.03,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G16","code_information":[{"code":"8578","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":128.12,"discounted_cash":64.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G17","code_information":[{"code":"8579","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":136.16,"discounted_cash":68.08,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G18","code_information":[{"code":"8580","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":143.9,"discounted_cash":71.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G19","code_information":[{"code":"8581","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G20","code_information":[{"code":"8582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":159.83,"discounted_cash":79.92,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G21","code_information":[{"code":"8583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":199.75,"discounted_cash":99.88,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G22","code_information":[{"code":"8584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.8,"discounted_cash":110.9,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G23","code_information":[{"code":"8585","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":258.59,"discounted_cash":129.29,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G24","code_information":[{"code":"8586","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.53,"discounted_cash":147.76,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G25","code_information":[{"code":"8587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.52,"discounted_cash":166.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G26","code_information":[{"code":"8588","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":369.72,"discounted_cash":184.86,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G27","code_information":[{"code":"8589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":508.03,"discounted_cash":254.01,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G28","code_information":[{"code":"8590","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":690.38,"discounted_cash":345.19,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G29","code_information":[{"code":"8591","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":847.13,"discounted_cash":423.56,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G30","code_information":[{"code":"8592","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":923.68,"discounted_cash":461.84,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G31","code_information":[{"code":"8593","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1077.66,"discounted_cash":538.83,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G32","code_information":[{"code":"8594","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1231.48,"discounted_cash":615.74,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G33","code_information":[{"code":"8595","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.72,"discounted_cash":692.86,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G34","code_information":[{"code":"8596","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1489.8,"discounted_cash":744.9,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G35","code_information":[{"code":"8597","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.82,"discounted_cash":808.41,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G36","code_information":[{"code":"8598","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1855.92,"discounted_cash":927.96,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G37","code_information":[{"code":"8599","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.52,"discounted_cash":1077.76,"setting":"both","billing_class":"facility"}]},{"description":"MED/SURG 1 SEMI-PVT","code_information":[{"code":"86","type":"CDM"},{"code":"121","type":"RC"},{"code":"92558","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1200.0,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G38","code_information":[{"code":"8600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.56,"discounted_cash":1212.28,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G39","code_information":[{"code":"8601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2694.11,"discounted_cash":1347.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G40","code_information":[{"code":"8602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3464.18,"discounted_cash":1732.09,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G41","code_information":[{"code":"8603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.64,"discounted_cash":2309.32,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G42","code_information":[{"code":"8604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5773.15,"discounted_cash":2886.57,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G43","code_information":[{"code":"8605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6927.62,"discounted_cash":3463.81,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G44","code_information":[{"code":"8606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8082.5,"discounted_cash":4041.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G45","code_information":[{"code":"8607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9237.17,"discounted_cash":4618.59,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G46","code_information":[{"code":"8608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10391.9,"discounted_cash":5195.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G47","code_information":[{"code":"8609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11546.21,"discounted_cash":5773.1,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G48","code_information":[{"code":"8610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10584.28,"discounted_cash":5292.14,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G49","code_information":[{"code":"8611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11546.47,"discounted_cash":5773.23,"setting":"both","billing_class":"facility"}]},{"description":"IMP JIP JOINT G52","code_information":[{"code":"8612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":13745.77,"discounted_cash":6872.89,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G53","code_information":[{"code":"8613","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":13963.97,"discounted_cash":6981.98,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G61","code_information":[{"code":"8614","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":22165.02,"discounted_cash":11082.51,"setting":"both","billing_class":"facility"}]},{"description":"IMP HIP JOINT G62","code_information":[{"code":"8615","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":24935.69,"discounted_cash":12467.84,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G63","code_information":[{"code":"8616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":26598.07,"discounted_cash":13299.03,"setting":"both","billing_class":"facility"}]},{"description":"IMP IOL G25","code_information":[{"code":"8618","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.52,"discounted_cash":166.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP IOL G27","code_information":[{"code":"8619","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":508.03,"discounted_cash":254.01,"setting":"both","billing_class":"facility"}]},{"description":"IMP IOL G28","code_information":[{"code":"8620","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":677.37,"discounted_cash":338.69,"setting":"both","billing_class":"facility"}]},{"description":"IMP IOL PC G34","code_information":[{"code":"8621","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.49,"discounted_cash":769.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G27","code_information":[{"code":"8623","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":508.03,"discounted_cash":254.01,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G28","code_information":[{"code":"8624","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":677.37,"discounted_cash":338.69,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G29","code_information":[{"code":"8625","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.71,"discounted_cash":423.36,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G30","code_information":[{"code":"8626","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.71,"discounted_cash":423.36,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G31","code_information":[{"code":"8627","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":923.68,"discounted_cash":461.84,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G32","code_information":[{"code":"8628","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":983.45,"discounted_cash":491.73,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G33","code_information":[{"code":"8629","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1231.58,"discounted_cash":615.79,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G34","code_information":[{"code":"8630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.57,"discounted_cash":692.78,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G35","code_information":[{"code":"8631","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.95,"discounted_cash":569.48,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G36","code_information":[{"code":"8632","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1972.8,"discounted_cash":986.4,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G37","code_information":[{"code":"8633","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.26,"discounted_cash":1077.63,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G38","code_information":[{"code":"8634","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2477.9,"discounted_cash":1238.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G39","code_information":[{"code":"8635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2694.11,"discounted_cash":1347.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G40","code_information":[{"code":"8636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3445.78,"discounted_cash":1722.89,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G41","code_information":[{"code":"8637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.64,"discounted_cash":2309.32,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G42","code_information":[{"code":"8638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5765.94,"discounted_cash":2882.97,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G43","code_information":[{"code":"8639","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":7034.05,"discounted_cash":3517.03,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G45","code_information":[{"code":"8640","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9237.17,"discounted_cash":4618.59,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G46","code_information":[{"code":"8641","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10391.85,"discounted_cash":5195.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G47","code_information":[{"code":"8642","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11546.47,"discounted_cash":5773.23,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G48","code_information":[{"code":"8643","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10584.28,"discounted_cash":5292.14,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G49","code_information":[{"code":"8644","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11546.47,"discounted_cash":5773.23,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G51","code_information":[{"code":"8645","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":12829.36,"discounted_cash":6414.68,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G52","code_information":[{"code":"8646","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":14433.12,"discounted_cash":7216.56,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G53","code_information":[{"code":"8647","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":14662.19,"discounted_cash":7331.1,"setting":"both","billing_class":"facility"}]},{"description":"COIL EMBOLIZATION DT","code_information":[{"code":"8648","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1198.51,"discounted_cash":599.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP KNEE JOINT G56","code_information":[{"code":"8649","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":17411.37,"discounted_cash":8705.68,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G24","code_information":[{"code":"8651","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.63,"discounted_cash":147.81,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G25","code_information":[{"code":"8652","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.52,"discounted_cash":166.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G27","code_information":[{"code":"8654","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":508.03,"discounted_cash":254.01,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G28","code_information":[{"code":"8655","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":677.42,"discounted_cash":338.71,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G29","code_information":[{"code":"8656","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":847.02,"discounted_cash":423.51,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G30","code_information":[{"code":"8657","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":924.09,"discounted_cash":462.05,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G31","code_information":[{"code":"8658","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1077.5,"discounted_cash":538.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G32","code_information":[{"code":"8659","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1231.48,"discounted_cash":615.74,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G33","code_information":[{"code":"8660","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.62,"discounted_cash":692.81,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G34","code_information":[{"code":"8661","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.49,"discounted_cash":769.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G35","code_information":[{"code":"8662","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1617.19,"discounted_cash":808.6,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G36","code_information":[{"code":"8663","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1885.81,"discounted_cash":942.9,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G37","code_information":[{"code":"8664","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.26,"discounted_cash":1077.63,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G38","code_information":[{"code":"8665","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.77,"discounted_cash":1212.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G39","code_information":[{"code":"8666","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2694.11,"discounted_cash":1347.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G40","code_information":[{"code":"8667","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3464.33,"discounted_cash":1732.16,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G41","code_information":[{"code":"8668","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.69,"discounted_cash":2309.34,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G42","code_information":[{"code":"8669","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5773.15,"discounted_cash":2886.57,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G43","code_information":[{"code":"8670","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6927.88,"discounted_cash":3463.94,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G48","code_information":[{"code":"8675","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10080.54,"discounted_cash":5040.27,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G50","code_information":[{"code":"8677","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11912.95,"discounted_cash":5956.48,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G51","code_information":[{"code":"8678","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":12829.41,"discounted_cash":6414.7,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G54","code_information":[{"code":"8681","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":16357.44,"discounted_cash":8178.72,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G58","code_information":[{"code":"8682","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":21656.01,"discounted_cash":10828.0,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH G60","code_information":[{"code":"8683","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":24192.38,"discounted_cash":12096.19,"setting":"both","billing_class":"facility"}]},{"description":"IMP NAILS G35","code_information":[{"code":"8684","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.51,"discounted_cash":808.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP NAILS G36","code_information":[{"code":"8685","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1885.86,"discounted_cash":942.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP NAILS G37","code_information":[{"code":"8686","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.26,"discounted_cash":1077.63,"setting":"both","billing_class":"facility"}]},{"description":"IMP NAILS G38","code_information":[{"code":"8687","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.77,"discounted_cash":1212.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP NAILS G39","code_information":[{"code":"8688","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2694.11,"discounted_cash":1347.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP NAILS G40","code_information":[{"code":"8689","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP NAILS G41","code_information":[{"code":"8690","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.64,"discounted_cash":2309.32,"setting":"both","billing_class":"facility"}]},{"description":"IMP NAILS G42","code_information":[{"code":"8691","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5640.13,"discounted_cash":2820.07,"setting":"both","billing_class":"facility"}]},{"description":"IMP NAILS G43","code_information":[{"code":"8692","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6927.88,"discounted_cash":3463.94,"setting":"both","billing_class":"facility"}]},{"description":"IMP NAILS G44","code_information":[{"code":"8693","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8454.89,"discounted_cash":4227.44,"setting":"both","billing_class":"facility"}]},{"description":"IMP NAILS G45","code_information":[{"code":"8694","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9237.17,"discounted_cash":4618.59,"setting":"both","billing_class":"facility"}]},{"description":"IMP NEURO GEN G40","code_information":[{"code":"8695","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP NEURO GEN G44","code_information":[{"code":"8696","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8082.5,"discounted_cash":4041.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP NEURO GEN G57","code_information":[{"code":"8697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":18327.68,"discounted_cash":9163.84,"setting":"both","billing_class":"facility"}]},{"description":"IMP NEURO GEN G59","code_information":[{"code":"8698","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":25123.47,"discounted_cash":12561.74,"setting":"both","billing_class":"facility"}]},{"description":"IMP NEURO GEN G61","code_information":[{"code":"8699","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":26941.77,"discounted_cash":13470.89,"setting":"both","billing_class":"facility"}]},{"description":"MED/SURG 1 ISOLATION","code_information":[{"code":"87","type":"CDM"},{"code":"164","type":"RC"},{"code":"92558","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":1189.75,"discounted_cash":594.88,"setting":"both","billing_class":"facility"}]},{"description":"IMP NEURO GEN G66","code_information":[{"code":"8700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":32291.7,"discounted_cash":16145.85,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G30","code_information":[{"code":"8701","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":923.68,"discounted_cash":461.84,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G31","code_information":[{"code":"8702","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1026.35,"discounted_cash":513.17,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G35","code_information":[{"code":"8703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.77,"discounted_cash":808.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G39","code_information":[{"code":"8704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2565.79,"discounted_cash":1282.89,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G40","code_information":[{"code":"8705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3298.91,"discounted_cash":1649.45,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G41","code_information":[{"code":"8706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.53,"discounted_cash":2309.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G42","code_information":[{"code":"8707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5640.18,"discounted_cash":2820.09,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G44","code_information":[{"code":"8708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":7697.63,"discounted_cash":3848.82,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G45","code_information":[{"code":"8709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8797.33,"discounted_cash":4398.66,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G46","code_information":[{"code":"8710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9896.99,"discounted_cash":4948.49,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G47","code_information":[{"code":"8711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10996.64,"discounted_cash":5498.32,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G48","code_information":[{"code":"8712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10080.23,"discounted_cash":5040.11,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G49","code_information":[{"code":"8713","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10996.64,"discounted_cash":5498.32,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G50","code_information":[{"code":"8714","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11912.95,"discounted_cash":5956.48,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G51","code_information":[{"code":"8715","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":12829.36,"discounted_cash":6414.68,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G52","code_information":[{"code":"8716","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":13745.77,"discounted_cash":6872.89,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G53","code_information":[{"code":"8717","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":15395.31,"discounted_cash":7697.65,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G54","code_information":[{"code":"8718","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":16357.8,"discounted_cash":8178.9,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G55","code_information":[{"code":"8719","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":16494.91,"discounted_cash":8247.45,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G56","code_information":[{"code":"8720","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":17411.37,"discounted_cash":8705.68,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G57","code_information":[{"code":"8721","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":19244.04,"discounted_cash":9622.02,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G58","code_information":[{"code":"8722","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":21168.41,"discounted_cash":10584.2,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G59","code_information":[{"code":"8723","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":21993.28,"discounted_cash":10996.64,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE G60","code_information":[{"code":"8724","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":23826.0,"discounted_cash":11913.0,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G01","code_information":[{"code":"8725","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":4.6,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G02","code_information":[{"code":"8726","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":9.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G03","code_information":[{"code":"8727","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":28.58,"discounted_cash":14.29,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G04","code_information":[{"code":"8728","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.94,"discounted_cash":18.47,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G05","code_information":[{"code":"8729","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.14,"discounted_cash":23.07,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G06","code_information":[{"code":"8730","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":51.62,"discounted_cash":25.81,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G07","code_information":[{"code":"8731","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.35,"discounted_cash":30.18,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G08","code_information":[{"code":"8732","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":68.81,"discounted_cash":34.41,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G09","code_information":[{"code":"8733","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":79.42,"discounted_cash":39.71,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G10","code_information":[{"code":"8734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.26,"discounted_cash":43.13,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G11","code_information":[{"code":"8735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.09,"discounted_cash":44.05,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G12","code_information":[{"code":"8736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.19,"discounted_cash":48.09,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G13","code_information":[{"code":"8737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.72,"discounted_cash":51.86,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G14","code_information":[{"code":"8738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.97,"discounted_cash":55.98,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G15","code_information":[{"code":"8739","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.07,"discounted_cash":60.03,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G16","code_information":[{"code":"8740","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":128.12,"discounted_cash":64.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G17","code_information":[{"code":"8741","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":136.16,"discounted_cash":68.08,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G18","code_information":[{"code":"8742","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":143.9,"discounted_cash":71.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G19","code_information":[{"code":"8743","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.89,"discounted_cash":75.94,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G20","code_information":[{"code":"8744","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":160.15,"discounted_cash":80.08,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G21","code_information":[{"code":"8745","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":200.01,"discounted_cash":100.0,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G22","code_information":[{"code":"8746","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.91,"discounted_cash":110.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G23","code_information":[{"code":"8747","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":258.59,"discounted_cash":129.29,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G24","code_information":[{"code":"8748","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":309.22,"discounted_cash":154.61,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G25","code_information":[{"code":"8749","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.52,"discounted_cash":166.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G26","code_information":[{"code":"8750","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":369.51,"discounted_cash":184.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G27","code_information":[{"code":"8751","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":508.03,"discounted_cash":254.01,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G28","code_information":[{"code":"8752","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":701.25,"discounted_cash":350.63,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G29","code_information":[{"code":"8753","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.71,"discounted_cash":423.36,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G30","code_information":[{"code":"8754","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":966.26,"discounted_cash":483.13,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G31","code_information":[{"code":"8755","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1077.66,"discounted_cash":538.83,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G32","code_information":[{"code":"8756","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1231.64,"discounted_cash":615.82,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G33","code_information":[{"code":"8757","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.57,"discounted_cash":692.78,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G34","code_information":[{"code":"8758","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.49,"discounted_cash":769.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G36","code_information":[{"code":"8759","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1972.8,"discounted_cash":986.4,"setting":"both","billing_class":"facility"}]},{"description":"IMP PIN/WIRE/ROD G41","code_information":[{"code":"8760","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.53,"discounted_cash":2309.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G22","code_information":[{"code":"8763","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.7,"discounted_cash":110.85,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G23","code_information":[{"code":"8764","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":258.59,"discounted_cash":129.29,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G24","code_information":[{"code":"8765","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.63,"discounted_cash":147.81,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G25","code_information":[{"code":"8766","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":347.88,"discounted_cash":173.94,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G26","code_information":[{"code":"8767","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":369.51,"discounted_cash":184.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G27","code_information":[{"code":"8768","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":508.03,"discounted_cash":254.01,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G28","code_information":[{"code":"8769","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":687.98,"discounted_cash":343.99,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G29","code_information":[{"code":"8770","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.71,"discounted_cash":423.36,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G30","code_information":[{"code":"8771","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":966.26,"discounted_cash":483.13,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G31","code_information":[{"code":"8772","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1077.66,"discounted_cash":538.83,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G32","code_information":[{"code":"8773","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1231.43,"discounted_cash":615.72,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G33","code_information":[{"code":"8774","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.57,"discounted_cash":692.78,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G34","code_information":[{"code":"8775","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1540.02,"discounted_cash":770.01,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G35","code_information":[{"code":"8776","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.72,"discounted_cash":808.36,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G36","code_information":[{"code":"8777","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1886.23,"discounted_cash":943.12,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G37","code_information":[{"code":"8778","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.68,"discounted_cash":1077.84,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G38","code_information":[{"code":"8779","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.77,"discounted_cash":1212.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G39","code_information":[{"code":"8780","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2771.24,"discounted_cash":1385.62,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G40","code_information":[{"code":"8781","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3464.12,"discounted_cash":1732.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G41","code_information":[{"code":"8782","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.59,"discounted_cash":2309.3,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G42","code_information":[{"code":"8783","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5773.15,"discounted_cash":2886.57,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G43","code_information":[{"code":"8784","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":7247.13,"discounted_cash":3623.57,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G44","code_information":[{"code":"8785","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8082.5,"discounted_cash":4041.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP PLATE G45","code_information":[{"code":"8786","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9237.17,"discounted_cash":4618.59,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM DUAL G46","code_information":[{"code":"8787","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9896.99,"discounted_cash":4948.49,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM DUAL G47","code_information":[{"code":"8788","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1785","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10996.64,"discounted_cash":5498.32,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM DUAL G48","code_information":[{"code":"8789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1785","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10584.28,"discounted_cash":5292.14,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM DUAL G49","code_information":[{"code":"8790","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1785","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10996.64,"discounted_cash":5498.32,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM DUAL G50","code_information":[{"code":"8791","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1785","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11912.95,"discounted_cash":5956.48,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM DUAL G51","code_information":[{"code":"8792","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":12829.36,"discounted_cash":6414.68,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN ART/AUG G43","code_information":[{"code":"8793","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1785","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6927.88,"discounted_cash":3463.94,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM LEAD SGL G36","code_information":[{"code":"8794","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1779","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1885.86,"discounted_cash":942.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM LEAD SGL G41","code_information":[{"code":"8795","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1779","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.53,"discounted_cash":2309.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM OTHR G35","code_information":[{"code":"8796","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2621","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.51,"discounted_cash":808.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM OTHR G46","code_information":[{"code":"8797","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10391.85,"discounted_cash":5195.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM OTHR G47","code_information":[{"code":"8798","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11546.47,"discounted_cash":5773.23,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM OTHR G48","code_information":[{"code":"8799","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":10584.28,"discounted_cash":5292.14,"setting":"both","billing_class":"facility"}]},{"description":"M/S 1 OBS 1ST HR","code_information":[{"code":"88","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":620.0,"discounted_cash":310.0,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM OTHR G49","code_information":[{"code":"8800","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11546.47,"discounted_cash":5773.23,"setting":"both","billing_class":"facility"}]},{"description":"IMP PM OTHR G50","code_information":[{"code":"8801","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":12508.7,"discounted_cash":6254.35,"setting":"both","billing_class":"facility"}]},{"description":"PORTPOWER DUO MRI9.5","code_information":[{"code":"8803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1077.66,"discounted_cash":538.83,"setting":"both","billing_class":"facility"}]},{"description":"IMP PORT G33","code_information":[{"code":"8804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.67,"discounted_cash":692.84,"setting":"both","billing_class":"facility"}]},{"description":"IMP PORT G35","code_information":[{"code":"8806","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.51,"discounted_cash":808.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP PROS UR SPH G49","code_information":[{"code":"8807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1815","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":12078.53,"discounted_cash":6039.27,"setting":"both","billing_class":"facility"}]},{"description":"MATRIX MESH BL 2X2","code_information":[{"code":"8808","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4104","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2233.48,"discounted_cash":1116.74,"setting":"both","billing_class":"facility"}]},{"description":"CLARIXFLO 100ML","code_information":[{"code":"8809","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4155","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":7247.13,"discounted_cash":3623.57,"setting":"both","billing_class":"facility"}]},{"description":"IMP SP CAGE G42","code_information":[{"code":"8810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5640.13,"discounted_cash":2820.07,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G04","code_information":[{"code":"8811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.94,"discounted_cash":18.47,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G05","code_information":[{"code":"8812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":46.14,"discounted_cash":23.07,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G06","code_information":[{"code":"8813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":51.52,"discounted_cash":25.76,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G07","code_information":[{"code":"8814","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.35,"discounted_cash":30.18,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G08","code_information":[{"code":"8815","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":68.87,"discounted_cash":34.44,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G09","code_information":[{"code":"8816","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.75,"discounted_cash":38.88,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G10","code_information":[{"code":"8817","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.32,"discounted_cash":43.16,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G11","code_information":[{"code":"8818","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.99,"discounted_cash":43.99,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G12","code_information":[{"code":"8819","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.93,"discounted_cash":47.97,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G13","code_information":[{"code":"8820","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.87,"discounted_cash":51.94,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G14","code_information":[{"code":"8821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.97,"discounted_cash":55.98,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G14","code_information":[{"code":"8822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.02,"discounted_cash":60.01,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G16","code_information":[{"code":"8823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":128.12,"discounted_cash":64.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G17","code_information":[{"code":"8824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":136.16,"discounted_cash":68.08,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G18","code_information":[{"code":"8825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":143.9,"discounted_cash":71.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G19","code_information":[{"code":"8826","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G20","code_information":[{"code":"8827","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":160.15,"discounted_cash":80.08,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G21","code_information":[{"code":"8828","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":199.86,"discounted_cash":99.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G22","code_information":[{"code":"8829","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.8,"discounted_cash":110.9,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G23","code_information":[{"code":"8830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.41,"discounted_cash":166.21,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G24","code_information":[{"code":"8831","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.21,"discounted_cash":147.6,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G25","code_information":[{"code":"8832","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.52,"discounted_cash":166.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G28","code_information":[{"code":"8833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":369.67,"discounted_cash":184.84,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G27","code_information":[{"code":"8834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":501.44,"discounted_cash":250.72,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G28","code_information":[{"code":"8835","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":757.94,"discounted_cash":378.97,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G29","code_information":[{"code":"8836","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.76,"discounted_cash":423.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G30","code_information":[{"code":"8837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":923.94,"discounted_cash":461.97,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G31","code_information":[{"code":"8838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1077.66,"discounted_cash":538.83,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G32","code_information":[{"code":"8839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1231.43,"discounted_cash":615.72,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G33","code_information":[{"code":"8840","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1382.43,"discounted_cash":691.22,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G34","code_information":[{"code":"8841","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1290.0,"discounted_cash":645.0,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G35","code_information":[{"code":"8842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.93,"discounted_cash":808.47,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G36","code_information":[{"code":"8843","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1885.81,"discounted_cash":942.9,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G37","code_information":[{"code":"8844","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.73,"discounted_cash":1077.87,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G38","code_information":[{"code":"8845","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1253.27,"discounted_cash":626.63,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G39","code_information":[{"code":"8846","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2694.11,"discounted_cash":1347.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G40","code_information":[{"code":"8847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3464.33,"discounted_cash":1732.16,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G41","code_information":[{"code":"8848","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.53,"discounted_cash":2309.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW G42","code_information":[{"code":"8849","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5773.15,"discounted_cash":2886.57,"setting":"both","billing_class":"facility"}]},{"description":"KIT KEPHO W CEMENT","code_information":[{"code":"8850","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6348.69,"discounted_cash":3174.34,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G17","code_information":[{"code":"8858","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":136.16,"discounted_cash":68.08,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G18","code_information":[{"code":"8859","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":143.9,"discounted_cash":71.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G19","code_information":[{"code":"8860","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G20","code_information":[{"code":"8861","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":160.15,"discounted_cash":80.08,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G21","code_information":[{"code":"8862","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":200.01,"discounted_cash":100.0,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G22","code_information":[{"code":"8863","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.7,"discounted_cash":110.85,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G23","code_information":[{"code":"8864","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":258.59,"discounted_cash":129.29,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G24","code_information":[{"code":"8865","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.21,"discounted_cash":147.6,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G25","code_information":[{"code":"8866","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.52,"discounted_cash":166.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G26","code_information":[{"code":"8867","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":369.51,"discounted_cash":184.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G27","code_information":[{"code":"8868","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":515.45,"discounted_cash":257.73,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G28","code_information":[{"code":"8869","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":392.5,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G29","code_information":[{"code":"8870","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.97,"discounted_cash":423.49,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G30","code_information":[{"code":"8871","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":923.68,"discounted_cash":461.84,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G31","code_information":[{"code":"8872","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.3,"discounted_cash":808.15,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G32","code_information":[{"code":"8873","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1231.64,"discounted_cash":615.82,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G33","code_information":[{"code":"8874","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.57,"discounted_cash":692.78,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G34","code_information":[{"code":"8875","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.49,"discounted_cash":769.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G35","code_information":[{"code":"8876","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.77,"discounted_cash":808.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G36","code_information":[{"code":"8877","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1885.86,"discounted_cash":942.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G37","code_information":[{"code":"8878","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.26,"discounted_cash":1077.63,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G38","code_information":[{"code":"8879","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.77,"discounted_cash":1212.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G39","code_information":[{"code":"8880","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2335.21,"discounted_cash":1167.61,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G40","code_information":[{"code":"8881","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3464.02,"discounted_cash":1732.01,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G41","code_information":[{"code":"8882","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4778.26,"discounted_cash":2389.13,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G42","code_information":[{"code":"8883","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5906.18,"discounted_cash":2953.09,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G43","code_information":[{"code":"8884","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":7247.13,"discounted_cash":3623.57,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G44","code_information":[{"code":"8885","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8082.5,"discounted_cash":4041.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G45","code_information":[{"code":"8886","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9379.19,"discounted_cash":4689.6,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G46","code_information":[{"code":"8887","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10391.85,"discounted_cash":5195.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G47","code_information":[{"code":"8888","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11546.47,"discounted_cash":5773.23,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G48","code_information":[{"code":"8889","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10584.28,"discounted_cash":5292.14,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G49","code_information":[{"code":"8890","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11546.47,"discounted_cash":5773.23,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G50","code_information":[{"code":"8891","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":13309.43,"discounted_cash":6654.72,"setting":"both","billing_class":"facility"}]},{"description":"IMPL SHLD JOINT G51","code_information":[{"code":"8892","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":13420.57,"discounted_cash":6710.28,"setting":"both","billing_class":"facility"}]},{"description":"IMP SHLD JOINT G53","code_information":[{"code":"8893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":14662.19,"discounted_cash":7331.1,"setting":"both","billing_class":"facility"}]},{"description":"IMP SP CAGE G41","code_information":[{"code":"8894","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4398.67,"discounted_cash":2199.34,"setting":"both","billing_class":"facility"}]},{"description":"IMP SP CAGE G42","code_information":[{"code":"8895","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6069.2,"discounted_cash":3034.6,"setting":"both","billing_class":"facility"}]},{"description":"IMP SP CAGE G44","code_information":[{"code":"8896","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8082.5,"discounted_cash":4041.25,"setting":"both","billing_class":"facility"}]},{"description":"IMO SP CAGE G46 4000","code_information":[{"code":"8897","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":12248.39,"discounted_cash":6124.19,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS HMN G31","code_information":[{"code":"8898","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1077.66,"discounted_cash":538.83,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS HMN G32","code_information":[{"code":"8899","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1231.64,"discounted_cash":615.82,"setting":"both","billing_class":"facility"}]},{"description":"M/S 1 OBS ADD HR","code_information":[{"code":"89","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS HMN G33","code_information":[{"code":"8900","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.57,"discounted_cash":692.78,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS HMN G34","code_information":[{"code":"8901","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1540.02,"discounted_cash":770.01,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS HMN G35","code_information":[{"code":"8902","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.51,"discounted_cash":808.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS HMN G36","code_information":[{"code":"8903","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1885.86,"discounted_cash":942.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS HMN G37","code_information":[{"code":"8904","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.26,"discounted_cash":1077.63,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS HMN G38","code_information":[{"code":"8905","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.77,"discounted_cash":1212.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS HMN G43","code_information":[{"code":"8906","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6927.88,"discounted_cash":3463.94,"setting":"both","billing_class":"facility"}]},{"description":"CABLE ACCORD 265X11","code_information":[{"code":"8907","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":12816.93,"discounted_cash":6408.47,"setting":"both","billing_class":"facility"}]},{"description":"CABLE ACCORD 2.0MM","code_information":[{"code":"8908","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.11,"discounted_cash":353.06,"setting":"both","billing_class":"facility"}]},{"description":"BONE BIOFUSE VIABLE","code_information":[{"code":"8909","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2900.61,"discounted_cash":1450.31,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS NH G28","code_information":[{"code":"8910","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":677.37,"discounted_cash":338.69,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS NH G33","code_information":[{"code":"8911","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.57,"discounted_cash":692.78,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS NH G37","code_information":[{"code":"8912","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.26,"discounted_cash":1077.63,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS NH G38","code_information":[{"code":"8913","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.77,"discounted_cash":1212.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS NH G39","code_information":[{"code":"8914","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2694.11,"discounted_cash":1347.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS NH G40","code_information":[{"code":"8915","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS NH G41","code_information":[{"code":"8916","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.53,"discounted_cash":2309.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G35","code_information":[{"code":"8923","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.51,"discounted_cash":808.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G36","code_information":[{"code":"8924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1885.86,"discounted_cash":942.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G37","code_information":[{"code":"8925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2155.26,"discounted_cash":1077.63,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G38","code_information":[{"code":"8926","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.77,"discounted_cash":1212.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G39","code_information":[{"code":"8927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2694.11,"discounted_cash":1347.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G40","code_information":[{"code":"8928","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G41","code_information":[{"code":"8929","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.53,"discounted_cash":2309.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G42","code_information":[{"code":"8930","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5773.15,"discounted_cash":2886.57,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G43","code_information":[{"code":"8931","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6927.88,"discounted_cash":3463.94,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G44","code_information":[{"code":"8932","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8082.5,"discounted_cash":4041.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G45","code_information":[{"code":"8933","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9237.17,"discounted_cash":4618.59,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G46","code_information":[{"code":"8934","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10391.85,"discounted_cash":5195.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G47","code_information":[{"code":"8935","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":14961.37,"discounted_cash":7480.69,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G48","code_information":[{"code":"8936","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":13306.87,"discounted_cash":6653.44,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G58","code_information":[{"code":"8937","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":21168.41,"discounted_cash":10584.2,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G59","code_information":[{"code":"8938","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":27927.99,"discounted_cash":13964.0,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASC G60","code_information":[{"code":"8939","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":30255.31,"discounted_cash":15127.66,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR G63","code_information":[{"code":"8940","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":30790.61,"discounted_cash":15395.31,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUT/CAP G07","code_information":[{"code":"8941","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.35,"discounted_cash":30.18,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUT/CAP G08","code_information":[{"code":"8942","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":68.87,"discounted_cash":34.44,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUT/CAP G09","code_information":[{"code":"8943","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":77.75,"discounted_cash":38.88,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUT/CAP G10","code_information":[{"code":"8944","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":86.26,"discounted_cash":43.13,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUT/CAP G11","code_information":[{"code":"8945","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":88.09,"discounted_cash":44.05,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUT/CAP G12","code_information":[{"code":"8946","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":96.19,"discounted_cash":48.09,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUT/CAP G13","code_information":[{"code":"8947","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":103.87,"discounted_cash":51.94,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUT/CAP G14","code_information":[{"code":"8948","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.97,"discounted_cash":55.98,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUT/CAP G15","code_information":[{"code":"8949","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":120.07,"discounted_cash":60.03,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUT/CAP G16","code_information":[{"code":"8950","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":128.12,"discounted_cash":64.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUT/CAP G17","code_information":[{"code":"8951","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":136.16,"discounted_cash":68.08,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUT/CAP G18","code_information":[{"code":"8952","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":143.9,"discounted_cash":71.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUT/CAP G24","code_information":[{"code":"8953","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":309.22,"discounted_cash":154.61,"setting":"both","billing_class":"facility"}]},{"description":"IML WSHR/NUT/CAP G28","code_information":[{"code":"8955","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":540.27,"discounted_cash":270.13,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUT/CAP G29","code_information":[{"code":"8956","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.71,"discounted_cash":423.36,"setting":"both","billing_class":"facility"}]},{"description":"GFT KERECS 1SQCM(120","code_information":[{"code":"8957","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":246.21,"discounted_cash":123.11,"setting":"both","billing_class":"facility"}]},{"description":"INTR/SH FXD PEEL G28","code_information":[{"code":"8958","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4158","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":617.1,"discounted_cash":308.55,"setting":"both","billing_class":"facility"}]},{"description":"INTR/SH NCRD NLS G30","code_information":[{"code":"8959","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":879.68,"discounted_cash":439.84,"setting":"both","billing_class":"facility"}]},{"description":"INTR/SH NCRD NLS G31","code_information":[{"code":"8960","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1077.66,"discounted_cash":538.83,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM UROLIFT","code_information":[{"code":"8961","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2179.87,"discounted_cash":1089.93,"setting":"both","billing_class":"facility"}]},{"description":"ST CT/CV W/ DS G37","code_information":[{"code":"8962","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2052.69,"discounted_cash":1026.35,"setting":"both","billing_class":"facility"}]},{"description":"ST CT/CV W/DS G40","code_information":[{"code":"8963","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"ST CT/CV W/DS G41","code_information":[{"code":"8964","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.53,"discounted_cash":2309.26,"setting":"both","billing_class":"facility"}]},{"description":"ST CT/CV W/DS G42","code_information":[{"code":"8965","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5773.15,"discounted_cash":2886.57,"setting":"both","billing_class":"facility"}]},{"description":"ST CT/CV W/DS G43","code_information":[{"code":"8966","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6927.88,"discounted_cash":3463.94,"setting":"both","billing_class":"facility"}]},{"description":"ST CT/CV W/DS G44","code_information":[{"code":"8967","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8082.5,"discounted_cash":4041.25,"setting":"both","billing_class":"facility"}]},{"description":"ST CT/CV W/DS G45","code_information":[{"code":"8968","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9237.17,"discounted_cash":4618.59,"setting":"both","billing_class":"facility"}]},{"description":"ST CT/CV W/DS G50","code_information":[{"code":"8969","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11912.95,"discounted_cash":5956.48,"setting":"both","billing_class":"facility"}]},{"description":"ST NONCT/CV W/DS","code_information":[{"code":"8970","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2694.11,"discounted_cash":1347.06,"setting":"both","billing_class":"facility"}]},{"description":"ST NONCT/CV W/DS G40","code_information":[{"code":"8971","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"ST NONCT/CV W/DS G41","code_information":[{"code":"8972","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.53,"discounted_cash":2309.26,"setting":"both","billing_class":"facility"}]},{"description":"STENT LIFE 6X40/60","code_information":[{"code":"8973","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2529.21,"discounted_cash":1264.61,"setting":"both","billing_class":"facility"}]},{"description":"STENT LIFE 5X40/60","code_information":[{"code":"8974","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2639.15,"discounted_cash":1319.58,"setting":"both","billing_class":"facility"}]},{"description":"STENT LIFE 6X100","code_information":[{"code":"8975","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3408.95,"discounted_cash":1704.47,"setting":"both","billing_class":"facility"}]},{"description":"STENT LIFE 5X100","code_information":[{"code":"8976","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3628.87,"discounted_cash":1814.43,"setting":"both","billing_class":"facility"}]},{"description":"LIFE STENT 5 & 6X150","code_information":[{"code":"8977","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4068.76,"discounted_cash":2034.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP CABLE/CABLES G36","code_information":[{"code":"8978","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1885.86,"discounted_cash":942.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP NS LEAD G33","code_information":[{"code":"8979","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.57,"discounted_cash":692.78,"setting":"both","billing_class":"facility"}]},{"description":"IMP NS LEAD G45","code_information":[{"code":"8980","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9237.17,"discounted_cash":4618.59,"setting":"both","billing_class":"facility"}]},{"description":"IMP PROS UR SPH G15","code_information":[{"code":"8981","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1815","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5773.15,"discounted_cash":2886.57,"setting":"both","billing_class":"facility"}]},{"description":"IMP PROS UR SPH G19","code_information":[{"code":"8982","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1815","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":10391.85,"discounted_cash":5195.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP MTRL VOCAL CORD","code_information":[{"code":"8983","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1878","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1549.11,"discounted_cash":774.55,"setting":"both","billing_class":"facility"}]},{"description":"ST NC TEMP W/DS GC","code_information":[{"code":"8984","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":508.03,"discounted_cash":254.01,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR GRP U2","code_information":[{"code":"8985","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":12701.09,"discounted_cash":6350.55,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR GRP B3","code_information":[{"code":"8986","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":13855.76,"discounted_cash":6927.88,"setting":"both","billing_class":"facility"}]},{"description":"IMP WRIST JT G43","code_information":[{"code":"8987","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6927.88,"discounted_cash":3463.94,"setting":"both","billing_class":"facility"}]},{"description":"BEAD LINX 13-17","code_information":[{"code":"8988","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6966.18,"discounted_cash":3483.09,"setting":"both","billing_class":"facility"}]},{"description":"TOE TAPER POST 7X13","code_information":[{"code":"8989","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1143.7,"discounted_cash":571.85,"setting":"both","billing_class":"facility"}]},{"description":"TOE UNICAP VARIOUS S","code_information":[{"code":"8990","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4966.21,"discounted_cash":2483.11,"setting":"both","billing_class":"facility"}]},{"description":"MED/SURG 2 SEMI-PVT","code_information":[{"code":"9","type":"CDM"},{"code":"121","type":"RC"},{"code":"C1726","type":"HCPCS"},{"code":"305","type":"LOCAL"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":1200.0,"setting":"both","billing_class":"facility"}]},{"description":"LVL 1 EST O/P VISIT","code_information":[{"code":"90","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":419.62,"discounted_cash":209.81,"setting":"both","billing_class":"facility"}]},{"description":"NEEDLES G10","code_information":[{"code":"9047","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1898","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.6,"discounted_cash":39.3,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW GRP A","code_information":[{"code":"9059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":44.78,"discounted_cash":22.39,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW GRP B","code_information":[{"code":"9060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":350.96,"discounted_cash":175.48,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW GRP C","code_information":[{"code":"9061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":368.41,"discounted_cash":184.21,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW GRP D","code_information":[{"code":"9062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":501.5,"discounted_cash":250.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW GRP E","code_information":[{"code":"9063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":691.16,"discounted_cash":345.58,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW GRP F","code_information":[{"code":"9064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":788.66,"discounted_cash":394.33,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW GRP G","code_information":[{"code":"9065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1002.21,"discounted_cash":501.11,"setting":"both","billing_class":"facility"}]},{"description":"IMP SCREW GRP Z","code_information":[{"code":"9069","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2518.71,"discounted_cash":1259.36,"setting":"both","billing_class":"facility"}]},{"description":"IMP SYS BICEP RPR","code_information":[{"code":"9070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2290.01,"discounted_cash":1145.01,"setting":"both","billing_class":"facility"}]},{"description":"IMP SYS CRP VIPER","code_information":[{"code":"9071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1392.83,"discounted_cash":696.41,"setting":"both","billing_class":"facility"}]},{"description":"APPL UNNA BOOT RT","code_information":[{"code":"91","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.05,"discounted_cash":227.53,"setting":"both","billing_class":"facility"}]},{"description":"IMP WSHR/NUTS GRP A","code_information":[{"code":"9115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.81,"discounted_cash":41.91,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS GRP C","code_information":[{"code":"9121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":528.04,"discounted_cash":264.02,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS GRP D","code_information":[{"code":"9122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":567.23,"discounted_cash":283.62,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS GRP F","code_information":[{"code":"9123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":923.68,"discounted_cash":461.84,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS GRP H","code_information":[{"code":"9124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1217.95,"discounted_cash":608.98,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS GRP J","code_information":[{"code":"9126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1474.81,"discounted_cash":737.4,"setting":"both","billing_class":"facility"}]},{"description":"IMP ANCH/STPLS GRP Z","code_information":[{"code":"9127","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":789.34,"discounted_cash":394.67,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR GRP C","code_information":[{"code":"9130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":373.27,"discounted_cash":186.63,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR GRP D","code_information":[{"code":"9131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":536.87,"discounted_cash":268.44,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR GRP E","code_information":[{"code":"9132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":757.47,"discounted_cash":378.74,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR GRP F","code_information":[{"code":"9133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":992.65,"discounted_cash":496.32,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR GRP H","code_information":[{"code":"9135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1524.86,"discounted_cash":762.43,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR GRP I","code_information":[{"code":"9136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1937.9,"discounted_cash":968.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR GRP M","code_information":[{"code":"9140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2545.93,"discounted_cash":1272.96,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR GRP Q","code_information":[{"code":"9141","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR GRP S","code_information":[{"code":"9143","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3925.75,"discounted_cash":1962.88,"setting":"both","billing_class":"facility"}]},{"description":"IMP VASCULAR GRP Z","code_information":[{"code":"9144","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2824.16,"discounted_cash":1412.08,"setting":"both","billing_class":"facility"}]},{"description":"IMP MESH GRP K","code_information":[{"code":"9155","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1481.76,"discounted_cash":740.88,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS MARKR GRP B","code_information":[{"code":"9159","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":561.84,"discounted_cash":280.92,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS MARK GRP C","code_information":[{"code":"9160","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":277.03,"discounted_cash":138.51,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS MARK GRP D","code_information":[{"code":"9161","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":369.62,"discounted_cash":184.81,"setting":"both","billing_class":"facility"}]},{"description":"TRANSCAROTID STENT","code_information":[{"code":"9162","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5984.56,"discounted_cash":2992.28,"setting":"both","billing_class":"facility"}]},{"description":"APPL UNNA BOOT LT","code_information":[{"code":"92","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.05,"discounted_cash":227.53,"setting":"both","billing_class":"facility"}]},{"description":"IMP PENILE GRP F","code_information":[{"code":"9248","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.51,"discounted_cash":808.25,"setting":"both","billing_class":"facility"}]},{"description":"PENILE ASSEMBLY KIT","code_information":[{"code":"9252","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1175.7,"discounted_cash":587.85,"setting":"both","billing_class":"facility"}]},{"description":"PENILE CL RESERVOIR","code_information":[{"code":"9253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3391.23,"discounted_cash":1695.62,"setting":"both","billing_class":"facility"}]},{"description":"PENILE NARROW KIT","code_information":[{"code":"9254","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1813","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":702.95,"discounted_cash":351.48,"setting":"both","billing_class":"facility"}]},{"description":"IMP CTR PROSTHETIC","code_information":[{"code":"9270","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":643.51,"discounted_cash":321.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP PORT GRP E","code_information":[{"code":"9271","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.49,"discounted_cash":769.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP PORT GRP F","code_information":[{"code":"9272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1616.51,"discounted_cash":808.25,"setting":"both","billing_class":"facility"}]},{"description":"IMP PORT GRP Z","code_information":[{"code":"9273","type":"CDM"},{"code":"279","type":"RC"},{"code":"C1788","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1283.9,"discounted_cash":641.95,"setting":"both","billing_class":"facility"}]},{"description":"STENT PERC GLIDEX 24","code_information":[{"code":"9274","type":"CDM"},{"code":"279","type":"RC"},{"code":"C2617","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":412.15,"discounted_cash":206.07,"setting":"both","billing_class":"facility"}]},{"description":"APPL UNNA BOOT BILAT","code_information":[{"code":"93","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":766.2,"discounted_cash":383.1,"setting":"both","billing_class":"facility"}]},{"description":"ST NONCT/CV W/DS GN","code_information":[{"code":"9303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"ST NONCT/CV W/DS GY","code_information":[{"code":"9305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":12182.35,"discounted_cash":6091.18,"setting":"both","billing_class":"facility"}]},{"description":"ST URETERAL PIGTAIL","code_information":[{"code":"9339","type":"CDM"},{"code":"279","type":"RC"},{"code":"C2617","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":349.85,"discounted_cash":174.93,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISSUE NH GRP C","code_information":[{"code":"9348","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISSUE NH GRP D","code_information":[{"code":"9349","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3920.79,"discounted_cash":1960.39,"setting":"both","billing_class":"facility"}]},{"description":"IMP SYN URINARY 1ML","code_information":[{"code":"9355","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8606","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":951.52,"discounted_cash":475.76,"setting":"both","billing_class":"facility"}]},{"description":"UR INCONT DEV SL GFT","code_information":[{"code":"9356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2998.78,"discounted_cash":1499.39,"setting":"both","billing_class":"facility"}]},{"description":"KIT INFUSE BONEGFT S","code_information":[{"code":"9357","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":7590.41,"discounted_cash":3795.2,"setting":"both","billing_class":"facility"}]},{"description":"KIT INFUSE BONEGFT L","code_information":[{"code":"9358","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8993.43,"discounted_cash":4496.72,"setting":"both","billing_class":"facility"}]},{"description":"GRFT TSS PRCNE 15X20","code_information":[{"code":"9359","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":14379.62,"discounted_cash":7189.81,"setting":"both","billing_class":"facility"}]},{"description":"GRT TSS PRCNE 10X15","code_information":[{"code":"9360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8627.73,"discounted_cash":4313.86,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS HMN GRP A","code_information":[{"code":"9364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1034.6,"discounted_cash":517.3,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISSUE HMN GRP C","code_information":[{"code":"9366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISSUE HMN GRP D","code_information":[{"code":"9367","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":8313.45,"discounted_cash":4156.73,"setting":"both","billing_class":"facility"}]},{"description":"IMP TISS HMN GRP H","code_information":[{"code":"9370","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9237.17,"discounted_cash":4618.59,"setting":"both","billing_class":"facility"}]},{"description":"GRAFT ALLOMAX TISSUE","code_information":[{"code":"9372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9848.71,"discounted_cash":4924.35,"setting":"both","billing_class":"facility"}]},{"description":"GRAFT BILAY 2X2 4 SQ","code_information":[{"code":"9373","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1228.71,"discounted_cash":614.36,"setting":"both","billing_class":"facility"}]},{"description":"GRAFT BILAY 4X5 20SQ","code_information":[{"code":"9374","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4102","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":486.81,"discounted_cash":243.41,"setting":"both","billing_class":"facility"}]},{"description":"APP MLTL COMP LWR LG","code_information":[{"code":"94","type":"CDM"},{"code":"761","type":"RC"},{"code":"29581","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":455.05,"discounted_cash":227.53,"setting":"both","billing_class":"facility"}]},{"description":"INTR/SH NCRD NLAS GA","code_information":[{"code":"9410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.3,"discounted_cash":47.65,"setting":"both","billing_class":"facility"}]},{"description":"INTR/SH NCRD NLAS GB","code_information":[{"code":"9411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.68,"discounted_cash":86.84,"setting":"both","billing_class":"facility"}]},{"description":"INTR/SH NCRD NLAS GC","code_information":[{"code":"9412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":263.86,"discounted_cash":131.93,"setting":"both","billing_class":"facility"}]},{"description":"INTR/SH NCRD NLAS GD","code_information":[{"code":"9413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1894","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":351.96,"discounted_cash":175.98,"setting":"both","billing_class":"facility"}]},{"description":"IMP FILTER IVC LT","code_information":[{"code":"9440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.77,"discounted_cash":1212.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP FILTER IVC ST","code_information":[{"code":"9441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2424.77,"discounted_cash":1212.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP LEAD NEURO G34","code_information":[{"code":"9442","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.49,"discounted_cash":769.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP FILTR IVC LT G40","code_information":[{"code":"9443","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"IM LEAD NEURO G45","code_information":[{"code":"9444","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9237.17,"discounted_cash":4618.59,"setting":"both","billing_class":"facility"}]},{"description":"IMP LEAD NEURO G40","code_information":[{"code":"9445","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP LEAD NEURO G42","code_information":[{"code":"9446","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5773.15,"discounted_cash":2886.57,"setting":"both","billing_class":"facility"}]},{"description":"IMP LEAD NEURO G44","code_information":[{"code":"9447","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9829.53,"discounted_cash":4914.77,"setting":"both","billing_class":"facility"}]},{"description":"IMP LEAD NEURO G47","code_information":[{"code":"9448","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11546.47,"discounted_cash":5773.23,"setting":"both","billing_class":"facility"}]},{"description":"IMP LEAD NEURO G59","code_information":[{"code":"9450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":23092.88,"discounted_cash":11546.44,"setting":"both","billing_class":"facility"}]},{"description":"IMP FALLOPIAN INSERT","code_information":[{"code":"9461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3948.43,"discounted_cash":1974.21,"setting":"both","billing_class":"facility"}]},{"description":"SYSTEM WALLFLEX STNT","code_information":[{"code":"9462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6582.98,"discounted_cash":3291.49,"setting":"both","billing_class":"facility"}]},{"description":"PATCH FIBRIN SEALANT","code_information":[{"code":"9463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1974.63,"discounted_cash":987.32,"setting":"both","billing_class":"facility"}]},{"description":"NEG PRES WND TX <50","code_information":[{"code":"95","type":"CDM"},{"code":"761","type":"RC"},{"code":"97605","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":556.6,"discounted_cash":278.3,"setting":"both","billing_class":"facility"}]},{"description":"EVNT RCRDR CARDC G48","code_information":[{"code":"9543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1764","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":11545.06,"discounted_cash":5772.53,"setting":"both","billing_class":"facility"}]},{"description":"TISSUEMEND 3X3 9 SQ","code_information":[{"code":"9544","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.22,"discounted_cash":176.11,"setting":"both","billing_class":"facility"}]},{"description":"TISSUEMEND 5X6 30 SQ","code_information":[{"code":"9545","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":246.31,"discounted_cash":123.16,"setting":"both","billing_class":"facility"}]},{"description":"TISSUEMEND 6X10 60SQ","code_information":[{"code":"9546","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4100","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":155.71,"discounted_cash":77.86,"setting":"both","billing_class":"facility"}]},{"description":"STRATTICE MATRIX","code_information":[{"code":"9547","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4130","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":80.26,"discounted_cash":40.13,"setting":"both","billing_class":"facility"}]},{"description":"STRATTICE MAT PL 6X8","code_information":[{"code":"9548","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4130","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.76,"discounted_cash":38.38,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN GRAFT GRP A","code_information":[{"code":"9568","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4130","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1539.49,"discounted_cash":769.75,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN GRAFT GRP C","code_information":[{"code":"9570","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4130","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN GRAFT GRP D","code_information":[{"code":"9571","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4130","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4618.53,"discounted_cash":2309.26,"setting":"both","billing_class":"facility"}]},{"description":"IMP BN GRAFT GRP F","code_information":[{"code":"9573","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4130","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":6927.88,"discounted_cash":3463.94,"setting":"both","billing_class":"facility"}]},{"description":"IMPLANT TESTICULAR","code_information":[{"code":"9574","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3810.12,"discounted_cash":1905.06,"setting":"both","billing_class":"facility"}]},{"description":"IMP NRV STM LEAD KIT","code_information":[{"code":"9575","type":"CDM"},{"code":"279","type":"RC"},{"code":"C1897","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1237.45,"discounted_cash":618.73,"setting":"both","billing_class":"facility"}]},{"description":"IMP NEURO GEN GRP F","code_information":[{"code":"9581","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":20974.14,"discounted_cash":10487.07,"setting":"both","billing_class":"facility"}]},{"description":"SCREW DISTRATOR 14MM","code_information":[{"code":"9583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1828.59,"discounted_cash":914.29,"setting":"both","billing_class":"facility"}]},{"description":"IMPLANT MOBI-C 15X17","code_information":[{"code":"9584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":16490.78,"discounted_cash":8245.39,"setting":"both","billing_class":"facility"}]},{"description":"EVNT RCRDR CARDC G44","code_information":[{"code":"9587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1764","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9237.17,"discounted_cash":4618.59,"setting":"both","billing_class":"facility"}]},{"description":"AMNIOX CORD RT/12 SQ","code_information":[{"code":"9588","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4148","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.62,"discounted_cash":218.81,"setting":"both","billing_class":"facility"}]},{"description":"IMP PT PROGRAM GRP","code_information":[{"code":"9589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1787","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":5718.24,"discounted_cash":2859.12,"setting":"both","billing_class":"facility"}]},{"description":"IMP PT PROGRAM GP40","code_information":[{"code":"9590","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1787","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3463.91,"discounted_cash":1731.95,"setting":"both","billing_class":"facility"}]},{"description":"SLING ALTIS GYN 7.75","code_information":[{"code":"9591","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2211.43,"discounted_cash":1105.71,"setting":"both","billing_class":"facility"}]},{"description":"DVT TVT ADVNTGE FIT","code_information":[{"code":"9592","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1871.18,"discounted_cash":935.59,"setting":"both","billing_class":"facility"}]},{"description":"IMPLNT OSSIOFIBER HT","code_information":[{"code":"9593","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2277.89,"discounted_cash":1138.94,"setting":"both","billing_class":"facility"}]},{"description":"IMPLNT OSSIOFIBR HTK","code_information":[{"code":"9594","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2656.02,"discounted_cash":1328.01,"setting":"both","billing_class":"facility"}]},{"description":"SEAMGUARD BIOABSRBLE","code_information":[{"code":"9595","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":650.98,"discounted_cash":325.49,"setting":"both","billing_class":"facility"}]},{"description":"CABLE CERCLAGE 1.8MM","code_information":[{"code":"9596","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":785.58,"discounted_cash":392.79,"setting":"both","billing_class":"facility"}]},{"description":"BUTTON CABLE NCB","code_information":[{"code":"9597","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"365","type":"LOCAL"}],"standard_charges":[{"gross_charge":438.85,"discounted_cash":219.43,"setting":"both","billing_class":"facility"}]},{"description":"TUBE ET 5MM 6MM","code_information":[{"code":"9598","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":48.3,"discounted_cash":24.15,"setting":"both","billing_class":"facility"}]},{"description":"TUBE ENDOTRACHEAL","code_information":[{"code":"9599","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":446.5,"discounted_cash":223.25,"setting":"both","billing_class":"facility"}]},{"description":"NEG PRES WND TX >50","code_information":[{"code":"96","type":"CDM"},{"code":"761","type":"RC"},{"code":"97606","type":"CPT"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.4,"discounted_cash":487.7,"setting":"both","billing_class":"facility"}]},{"description":"HNDPCE MINERVA MIN97","code_information":[{"code":"9600","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2014.15,"discounted_cash":1007.08,"setting":"both","billing_class":"facility"}]},{"description":"CATH MALE PUREWICK","code_information":[{"code":"9601","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1781","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.4,"discounted_cash":30.7,"setting":"both","billing_class":"facility"}]},{"description":"KIT INTEL TRIAL LEAD","code_information":[{"code":"9602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5372.4,"discounted_cash":2686.2,"setting":"both","billing_class":"facility"}]},{"description":"LEAD NEUROSTIM 60 X5","code_information":[{"code":"9603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1871.07,"discounted_cash":935.53,"setting":"both","billing_class":"facility"}]},{"description":"PROG NEUROSTM INTELL","code_information":[{"code":"9604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1787","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.55,"discounted_cash":293.77,"setting":"both","billing_class":"facility"}]},{"description":"NASOSPORE BIO 8CM","code_information":[{"code":"9605","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1787","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":678.3,"discounted_cash":339.15,"setting":"both","billing_class":"facility"}]},{"description":"EXTRACT KATZ FB REMV","code_information":[{"code":"9606","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1787","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":186.1,"discounted_cash":93.05,"setting":"both","billing_class":"facility"}]},{"description":"BOOT CAST SYSTEM","code_information":[{"code":"9607","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1787","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.2,"discounted_cash":151.6,"setting":"both","billing_class":"facility"}]},{"description":"JADA SYS HEMORRHAGE","code_information":[{"code":"9608","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1787","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2484.3,"discounted_cash":1242.15,"setting":"both","billing_class":"facility"}]},{"description":"GLIDESCOPE BFLEX 3.8","code_information":[{"code":"9609","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1787","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":664.75,"discounted_cash":332.38,"setting":"both","billing_class":"facility"}]},{"description":"TUBE MICKEY JEJUN 14","code_information":[{"code":"9610","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1787","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":447.5,"discounted_cash":223.75,"setting":"both","billing_class":"facility"}]},{"description":"CLAMP EXFIX LG 6 POS","code_information":[{"code":"9611","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1787","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2124.25,"discounted_cash":1062.13,"setting":"both","billing_class":"facility"}]},{"description":"CLAMP EXFIX LG COMB","code_information":[{"code":"9612","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1787","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1858.25,"discounted_cash":929.13,"setting":"both","billing_class":"facility"}]},{"description":"POST EXFIX OUTRIGGER","code_information":[{"code":"9613","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1787","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":439.25,"discounted_cash":219.63,"setting":"both","billing_class":"facility"}]},{"description":"SCREW 5.0 40 THREAD","code_information":[{"code":"9614","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":655.74,"discounted_cash":327.87,"setting":"both","billing_class":"facility"}]},{"description":"PIN STEINMN 5.0 250","code_information":[{"code":"9615","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":496.11,"discounted_cash":248.06,"setting":"both","billing_class":"facility"}]},{"description":"ROD EXFIX 11X150","code_information":[{"code":"9616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":764.16,"discounted_cash":382.08,"setting":"both","billing_class":"facility"}]},{"description":"ROD EXFIX 11X300","code_information":[{"code":"9617","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":819.8,"discounted_cash":409.9,"setting":"both","billing_class":"facility"}]},{"description":"ADAPTER AIRWAY","code_information":[{"code":"9619","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":258.15,"discounted_cash":129.07,"setting":"both","billing_class":"facility"}]},{"description":"ADAPTER MULTIFLOW","code_information":[{"code":"9631","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":7.88,"setting":"both","billing_class":"facility"}]},{"description":"AIRWAY LARYNGEAL","code_information":[{"code":"9641","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":92.25,"discounted_cash":46.13,"setting":"both","billing_class":"facility"}]},{"description":"DRILL BIT TWIST","code_information":[{"code":"9645","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":445.85,"discounted_cash":222.93,"setting":"both","billing_class":"facility"}]},{"description":"DRAPE MICROSCOPE","code_information":[{"code":"9652","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.1,"discounted_cash":39.05,"setting":"both","billing_class":"facility"}]},{"description":"ARTHROWAND","code_information":[{"code":"9653","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":547.85,"discounted_cash":273.93,"setting":"both","billing_class":"facility"}]},{"description":"BAG BILE","code_information":[{"code":"9658","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.65,"discounted_cash":16.82,"setting":"both","billing_class":"facility"}]},{"description":"BAG FEEDING","code_information":[{"code":"9662","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":6.3,"setting":"both","billing_class":"facility"}]},{"description":"BAG FLATUS","code_information":[{"code":"9663","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.45,"setting":"both","billing_class":"facility"}]},{"description":"APPLICATOR FLOSEAL","code_information":[{"code":"9673","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":198.85,"discounted_cash":99.42,"setting":"both","billing_class":"facility"}]},{"description":"BASIN SINGLE STR","code_information":[{"code":"9676","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":9.1,"discounted_cash":4.55,"setting":"both","billing_class":"facility"}]},{"description":"BASKET KIDNEY STONE","code_information":[{"code":"9680","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":534.65,"discounted_cash":267.32,"setting":"both","billing_class":"facility"}]},{"description":"BASKET STONE EXTRACT","code_information":[{"code":"9681","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":597.65,"discounted_cash":298.82,"setting":"both","billing_class":"facility"}]},{"description":"BASKET STONE SEGURE","code_information":[{"code":"9682","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":597.95,"discounted_cash":298.98,"setting":"both","billing_class":"facility"}]},{"description":"BINDER ABDOMINAL","code_information":[{"code":"9688","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":38.55,"discounted_cash":19.27,"setting":"both","billing_class":"facility"}]},{"description":"DRILL BIT","code_information":[{"code":"9692","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":42.25,"setting":"both","billing_class":"facility"}]},{"description":"DRILL BIT CANNU","code_information":[{"code":"9693","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1063.05,"discounted_cash":531.52,"setting":"both","billing_class":"facility"}]},{"description":"BLADE ACROMINIZER","code_information":[{"code":"9697","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":134.8,"discounted_cash":67.4,"setting":"both","billing_class":"facility"}]},{"description":"M/S 1 OBS DIRECT ADM","code_information":[{"code":"97","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0379","type":"HCPCS"},{"code":"316","type":"LOCAL"}],"standard_charges":[{"gross_charge":1597.07,"discounted_cash":798.53,"setting":"both","billing_class":"facility"}]},{"description":"BLADE BEAVER MINI","code_information":[{"code":"9703","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility"}]},{"description":"BLADE COR CUT INNO","code_information":[{"code":"9708","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.9,"discounted_cash":709.95,"setting":"both","billing_class":"facility"}]},{"description":"BLADE CRESCENT","code_information":[{"code":"9710","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.45,"discounted_cash":35.23,"setting":"both","billing_class":"facility"}]},{"description":"BLADE DERMATOME","code_information":[{"code":"9717","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":114.3,"discounted_cash":57.15,"setting":"both","billing_class":"facility"}]},{"description":"BLADE ENT","code_information":[{"code":"9721","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":450.95,"discounted_cash":225.47,"setting":"both","billing_class":"facility"}]},{"description":"BLADE FULL RAD","code_information":[{"code":"9726","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":141.7,"discounted_cash":70.85,"setting":"both","billing_class":"facility"}]},{"description":"BLADE HARMONIC","code_information":[{"code":"9727","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.8,"discounted_cash":353.4,"setting":"both","billing_class":"facility"}]},{"description":"BLADE INCISOR CV","code_information":[{"code":"9728","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":194.1,"discounted_cash":97.05,"setting":"both","billing_class":"facility"}]},{"description":"BLADE INCISOR ST","code_information":[{"code":"9729","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":177.1,"discounted_cash":88.55,"setting":"both","billing_class":"facility"}]},{"description":"BLADE KNIFE ARTHRO","code_information":[{"code":"9732","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility"}]},{"description":"BLADE KNIFE SLIT","code_information":[{"code":"9733","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":62.8,"discounted_cash":31.4,"setting":"both","billing_class":"facility"}]},{"description":"BLADE OSC","code_information":[{"code":"9740","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":160.95,"discounted_cash":80.47,"setting":"both","billing_class":"facility"}]},{"description":"BLADE PROFIX","code_information":[{"code":"9742","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.1,"discounted_cash":118.55,"setting":"both","billing_class":"facility"}]},{"description":"BLADE RADIUS FULL","code_information":[{"code":"9744","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.95,"discounted_cash":86.97,"setting":"both","billing_class":"facility"}]},{"description":"BLADE REAMER 41","code_information":[{"code":"9746","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":715.1,"discounted_cash":357.55,"setting":"both","billing_class":"facility"}]},{"description":"BLADE RECIPROCATOR","code_information":[{"code":"9748","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":214.65,"discounted_cash":107.33,"setting":"both","billing_class":"facility"}]},{"description":"BLADE SAGITAL NARROW","code_information":[{"code":"9751","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":100.25,"discounted_cash":50.13,"setting":"both","billing_class":"facility"}]},{"description":"BLADE SAGITAL STAND","code_information":[{"code":"9753","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":181.75,"discounted_cash":90.88,"setting":"both","billing_class":"facility"}]},{"description":"BLADE SAGITAL WIDE","code_information":[{"code":"9755","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":102.85,"discounted_cash":51.42,"setting":"both","billing_class":"facility"}]},{"description":"BLADE SAW ACL","code_information":[{"code":"9756","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.25,"discounted_cash":53.63,"setting":"both","billing_class":"facility"}]},{"description":"BLADE SAW GIGLI","code_information":[{"code":"9757","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":55.8,"discounted_cash":27.9,"setting":"both","billing_class":"facility"}]},{"description":"BLADE SAW OSCI","code_information":[{"code":"9759","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.8,"discounted_cash":15.4,"setting":"both","billing_class":"facility"}]},{"description":"BLADE SINUS XPS","code_information":[{"code":"9763","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":445.35,"discounted_cash":222.68,"setting":"both","billing_class":"facility"}]},{"description":"BLADE STRYKER","code_information":[{"code":"9769","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":107.55,"discounted_cash":53.77,"setting":"both","billing_class":"facility"}]},{"description":"BLADE TOM CAT","code_information":[{"code":"9775","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":173.95,"discounted_cash":86.97,"setting":"both","billing_class":"facility"}]},{"description":"BLADE TURB WISK","code_information":[{"code":"9778","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":141.7,"discounted_cash":70.85,"setting":"both","billing_class":"facility"}]},{"description":"BOLSTER","code_information":[{"code":"9789","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":16.1,"discounted_cash":8.05,"setting":"both","billing_class":"facility"}]},{"description":"BRACE WRIST","code_information":[{"code":"9813","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":21.2,"setting":"both","billing_class":"facility"}]},{"description":"BRUSH BRONCH","code_information":[{"code":"9817","type":"CDM"},{"code":"271","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":28.3,"discounted_cash":14.15,"setting":"both","billing_class":"facility"}]},{"description":"BRUSH CYTOLOGY","code_information":[{"code":"9819","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":21.2,"setting":"both","billing_class":"facility"}]},{"description":"BRUSH ERCP CYTO","code_information":[{"code":"9821","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.25,"discounted_cash":36.13,"setting":"both","billing_class":"facility"}]},{"description":"BURR DIAMOND","code_information":[{"code":"9828","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":272.85,"discounted_cash":136.43,"setting":"both","billing_class":"facility"}]},{"description":"BURR LINDEMAN","code_information":[{"code":"9830","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":160.95,"discounted_cash":80.47,"setting":"both","billing_class":"facility"}]},{"description":"BURR OVAL MED","code_information":[{"code":"9834","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":219.2,"discounted_cash":109.6,"setting":"both","billing_class":"facility"}]},{"description":"BURR ROUND MED","code_information":[{"code":"9838","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":147.9,"discounted_cash":73.95,"setting":"both","billing_class":"facility"}]},{"description":"BUTTON GASTRO DEVICE","code_information":[{"code":"9844","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":291.1,"discounted_cash":145.55,"setting":"both","billing_class":"facility"}]},{"description":"CANNISTER LINER MED","code_information":[{"code":"9849","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.85,"discounted_cash":18.93,"setting":"both","billing_class":"facility"}]},{"description":"CANNISTER OMNI JUG","code_information":[{"code":"9851","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":97.85,"discounted_cash":48.92,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA ARTHREX TWIS","code_information":[{"code":"9856","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.75,"discounted_cash":47.88,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA EYE","code_information":[{"code":"9860","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":22.4,"discounted_cash":11.2,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA SHOULDER","code_information":[{"code":"9866","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.75,"discounted_cash":58.38,"setting":"both","billing_class":"facility"}]},{"description":"CANNULA VISITEC","code_information":[{"code":"9868","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":24.45,"discounted_cash":12.22,"setting":"both","billing_class":"facility"}]},{"description":"CAP MALE VENTED","code_information":[{"code":"9872","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":416.7,"discounted_cash":208.35,"setting":"both","billing_class":"facility"}]},{"description":"CAP PROTECTIVE","code_information":[{"code":"9873","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":5.92,"setting":"both","billing_class":"facility"}]},{"description":"CASSETTE PHACO","code_information":[{"code":"9874","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":284.8,"discounted_cash":142.4,"setting":"both","billing_class":"facility"}]},{"description":"CAST SHOE","code_information":[{"code":"9900","type":"CDM"},{"code":"271","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":18.38,"setting":"both","billing_class":"facility"}]},{"description":"CAST SPLINT LEG LONG","code_information":[{"code":"9908","type":"CDM"},{"code":"271","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.15,"discounted_cash":14.57,"setting":"both","billing_class":"facility"}]},{"description":"CAST SPLINT LEG SHOR","code_information":[{"code":"9909","type":"CDM"},{"code":"271","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":29.15,"discounted_cash":14.57,"setting":"both","billing_class":"facility"}]},{"description":"CATH ABSCESS DRAIN","code_information":[{"code":"9910","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":251.1,"discounted_cash":125.55,"setting":"both","billing_class":"facility"}]},{"description":"CATH ANGIOGRAM","code_information":[{"code":"9912","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":61.4,"discounted_cash":30.7,"setting":"both","billing_class":"facility"}]},{"description":"CATH BAKER JEJUNOSTO","code_information":[{"code":"9914","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":318.85,"discounted_cash":159.43,"setting":"both","billing_class":"facility"}]},{"description":"CATH BALLOON BLUE MA","code_information":[{"code":"9917","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility"}]},{"description":"CATH BALLOON DILATOR","code_information":[{"code":"9919","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1574.25,"discounted_cash":787.13,"setting":"both","billing_class":"facility"}]},{"description":"CATH BALLOON DISTEN","code_information":[{"code":"9921","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":1107.6,"discounted_cash":553.8,"setting":"both","billing_class":"facility"}]},{"description":"CATH BALLOON PTA","code_information":[{"code":"9924","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":493.85,"discounted_cash":246.93,"setting":"both","billing_class":"facility"}]},{"description":"CATH BLLN PTA ADVANC","code_information":[{"code":"9925","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":935.8,"discounted_cash":467.9,"setting":"both","billing_class":"facility"}]},{"description":"CATH BARTHOLIN","code_information":[{"code":"9928","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":83.85,"discounted_cash":41.92,"setting":"both","billing_class":"facility"}]},{"description":"CATH BILIARY","code_information":[{"code":"9931","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":283.45,"discounted_cash":141.72,"setting":"both","billing_class":"facility"}]},{"description":"CATH BROVIAC","code_information":[{"code":"9934","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":371.1,"discounted_cash":185.55,"setting":"both","billing_class":"facility"}]},{"description":"CATH CHOLANGIOGRAM","code_information":[{"code":"9935","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":280.85,"discounted_cash":140.43,"setting":"both","billing_class":"facility"}]},{"description":"CATH CYSTO","code_information":[{"code":"9939","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":785.4,"discounted_cash":392.7,"setting":"both","billing_class":"facility"}]},{"description":"CATH DIAL QUNITON","code_information":[{"code":"9941","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":382.25,"discounted_cash":191.13,"setting":"both","billing_class":"facility"}]},{"description":"CATH DUAL LUMEN","code_information":[{"code":"9942","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":279.2,"discounted_cash":139.6,"setting":"both","billing_class":"facility"}]},{"description":"CATH ENDO DILATION","code_information":[{"code":"9943","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":697.7,"discounted_cash":348.85,"setting":"both","billing_class":"facility"}]},{"description":"CATH EPIDURAL","code_information":[{"code":"9944","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":76.4,"discounted_cash":38.2,"setting":"both","billing_class":"facility"}]},{"description":"CATH EPISTAXIS","code_information":[{"code":"9945","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.95,"discounted_cash":168.47,"setting":"both","billing_class":"facility"}]},{"description":"CATH EXTENSION","code_information":[{"code":"9953","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility"}]},{"description":"CATH FILIFORM DISP","code_information":[{"code":"9957","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":21.2,"setting":"both","billing_class":"facility"}]},{"description":"CATH FOGARTY VENOUS","code_information":[{"code":"9961","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":553.15,"discounted_cash":276.57,"setting":"both","billing_class":"facility"}]},{"description":"CATH FOLEY 2-WAY 30C","code_information":[{"code":"9963","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.65,"discounted_cash":16.82,"setting":"both","billing_class":"facility"}]},{"description":"CATH FOLEY 2-WAY 5CC","code_information":[{"code":"9964","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":15.25,"setting":"both","billing_class":"facility"}]},{"description":"CATH FOLEY 3-WAY 30C","code_information":[{"code":"9965","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":51.05,"discounted_cash":25.52,"setting":"both","billing_class":"facility"}]},{"description":"CATH FOLEY 3-WAY 5CC","code_information":[{"code":"9966","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.8,"discounted_cash":25.4,"setting":"both","billing_class":"facility"}]},{"description":"CATH FOLEY COUDE","code_information":[{"code":"9967","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":56.6,"discounted_cash":28.3,"setting":"both","billing_class":"facility"}]},{"description":"CATH FOGARTY EMBO","code_information":[{"code":"9969","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":118.75,"discounted_cash":59.38,"setting":"both","billing_class":"facility"}]},{"description":"CATH GROSHONG DUAL","code_information":[{"code":"9971","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":824.3,"discounted_cash":412.15,"setting":"both","billing_class":"facility"}]},{"description":"CATH HICKMAN DUAL","code_information":[{"code":"9977","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.5,"discounted_cash":196.75,"setting":"both","billing_class":"facility"}]},{"description":"CATH HICKMAN SINGLE","code_information":[{"code":"9978","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":386.85,"discounted_cash":193.43,"setting":"both","billing_class":"facility"}]},{"description":"CATH IMAGER TOURQ","code_information":[{"code":"9985","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":70.8,"discounted_cash":35.4,"setting":"both","billing_class":"facility"}]},{"description":"CATH INFUSION","code_information":[{"code":"9988","type":"CDM"},{"code":"272","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":164.5,"discounted_cash":82.25,"setting":"both","billing_class":"facility"}]},{"description":"CATH MALECOT MUSH","code_information":[{"code":"9998","type":"CDM"},{"code":"270","type":"RC"},{"code":"638","type":"LOCAL"}],"standard_charges":[{"gross_charge":40.65,"discounted_cash":20.32,"setting":"both","billing_class":"facility"}]},{"description":"Removal sutr&stapl xreq anes","code_information":[{"code":"15854","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.22,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Test for blood flow in graft","code_information":[{"code":"15860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":255.2,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":255.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":260.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":432.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.96,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":626.4,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":561.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Suction lipectomy head&neck","code_information":[{"code":"15876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":998.94,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":998.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1018.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal sutr/stapl xreq anes","code_information":[{"code":"15853","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.37,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Dressing change not for burn","code_information":[{"code":"15852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.53,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Remove sutures diff surgeon","code_information":[{"code":"15851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.62,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":155.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":158.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc Skin Abd Add-on","code_information":[{"code":"15847","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1172.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1195.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Skin and muscle repair face","code_information":[{"code":"15845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2528.87,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2528.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2578.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Nerve palsy microsurg graft","code_information":[{"code":"15842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1995.28,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6427.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6553.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Nerve palsy muscle graft","code_information":[{"code":"15841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3426.93,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4238.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4321.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Nerve palsy fascial graft","code_information":[{"code":"15840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2413.37,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2413.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2460.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Excise excess skin & tissue","code_information":[{"code":"15839","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1767.1,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1767.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1801.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Excise excess skin fat pad","code_information":[{"code":"15838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1545.34,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1545.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1575.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Excise excess skin arm/hand","code_information":[{"code":"15837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1706.54,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1706.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1740.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Excise excessive skin arm","code_information":[{"code":"15836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1898.79,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1898.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1936.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Excise excessive skin buttck","code_information":[{"code":"15835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2220.05,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2220.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2263.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Excise excessive skin hip","code_information":[{"code":"15834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2127.7,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2127.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2169.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Excise excessive skin leg","code_information":[{"code":"15833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2090.06,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2090.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2131.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Excise excessive skin thigh","code_information":[{"code":"15832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2200.0,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2200.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2243.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc Skin Abd","code_information":[{"code":"15830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2800.57,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2800.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2855.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6421.32,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6613.96,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9310.91,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8347.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Removal of skin wrinkles","code_information":[{"code":"15829","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3426.93,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6363.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6488.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of face wrinkles","code_information":[{"code":"15828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3426.93,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5694.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5806.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of brow wrinkles","code_information":[{"code":"15826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2176.68,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2176.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2219.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of neck wrinkles","code_information":[{"code":"15825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3014.83,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3014.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3074.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of forehead wrinkles","code_information":[{"code":"15824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1995.28,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2679.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2732.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Revision of upper eyelid","code_information":[{"code":"15823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1295.75,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1295.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1321.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Revision of upper eyelid","code_information":[{"code":"15822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":939.02,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":939.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":957.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Revision of lower eyelid","code_information":[{"code":"15821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1295.72,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1295.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1321.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Revision of lower eyelid","code_information":[{"code":"15820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1212.75,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1212.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1236.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Chemical peel nonfacial","code_information":[{"code":"15793","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":842.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":859.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Chemical peel nonfacial","code_information":[{"code":"15792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":493.41,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":493.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":503.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Chemical peel face dermal","code_information":[{"code":"15789","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":714.71,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":969.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":988.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Chemical peel face epiderm","code_information":[{"code":"15788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":508.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":518.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Abrasion lesions add-on","code_information":[{"code":"15787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.41,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Abrasion lesion single","code_information":[{"code":"15786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":320.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":327.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Dermabrasion suprfl any site","code_information":[{"code":"15783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":839.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":856.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Dermabrasion other than face","code_information":[{"code":"15782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":873.29,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":873.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":890.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Dermabrasion segmental face","code_information":[{"code":"15781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":684.79,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1009.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1028.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Dermabrasion total face","code_information":[{"code":"15780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1569.1,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1569.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1599.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Impl absrb msh/prsth dly cls","code_information":[{"code":"15778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":930.35,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":930.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":948.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Acellular derm matrix implt","code_information":[{"code":"15777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":512.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":512.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":522.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Hair trnspl >15 punch grafts","code_information":[{"code":"15776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":833.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":850.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Hair trnspl 1-15 punch grfts","code_information":[{"code":"15775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":607.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":619.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Gfrg autol fat lipo ea addl","code_information":[{"code":"15774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":341.83,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":341.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":348.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Grfg autol fat lipo 25 cc/<","code_information":[{"code":"15773","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1195.92,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1195.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1219.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Grfg autol fat lipo ea addl","code_information":[{"code":"15772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.95,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":353.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":360.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Grfg autol fat lipo 50 cc/<","code_information":[{"code":"15771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1220.75,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1220.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Derma-fat-fascia graft","code_information":[{"code":"15770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1604.63,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1604.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1636.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Grfg autol soft tiss dir exc","code_information":[{"code":"15769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1148.43,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1148.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1170.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Composite skin graft","code_information":[{"code":"15760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1659.96,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1659.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1692.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Free fascial flap microvasc","code_information":[{"code":"15758","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5394.37,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5394.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5500.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Free skin flap microvasc","code_information":[{"code":"15757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5417.91,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5417.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5524.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Free myo/skin flap microvasc","code_information":[{"code":"15756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5452.37,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5452.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5559.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Neurovascular pedicle flap","code_information":[{"code":"15750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2229.89,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2229.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2273.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Island pedicle flap graft","code_information":[{"code":"15740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1995.28,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2003.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2043.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Muscle-skin graft leg","code_information":[{"code":"15738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3027.92,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3027.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3087.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Muscle-skin graft arm","code_information":[{"code":"15736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1995.28,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2903.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2960.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Muscle-skin graft trunk","code_information":[{"code":"15734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3426.93,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3596.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3667.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Musc myoq/fscq flp h&n pedcl","code_information":[{"code":"15733","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2456.14,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2456.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2504.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Forehead Flap w/Vasc Pedicle","code_information":[{"code":"15731","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2372.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2372.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2419.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Mdfc flap w/prsrv vasc pedcl","code_information":[{"code":"15730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2170.41,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2170.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2213.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Transfer skin pedicle flap","code_information":[{"code":"15650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":959.59,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":959.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":978.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Delay flap eye/nos/ear/lip","code_information":[{"code":"15630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":814.61,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":814.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":830.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Delay flap f/c/c/n/ax/g/h/f","code_information":[{"code":"15620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":774.21,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":774.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":789.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Delay flap arms/legs","code_information":[{"code":"15610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":578.41,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":578.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":589.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Delay flap trunk","code_information":[{"code":"15600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":501.05,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":501.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":510.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Pedicle e/n/e/l/ntroral","code_information":[{"code":"15576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1537.83,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1537.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1568.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Pedcle fh/ch/ch/m/n/ax/g/h/f","code_information":[{"code":"15574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1763.69,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1763.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1798.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Skin pedicle flap arms/legs","code_information":[{"code":"15572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1754.64,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1754.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1789.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Skin pedicle flap trunk","code_information":[{"code":"15570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1738.55,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1738.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1772.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Skn sub grft f/n/hf/g ch add","code_information":[{"code":"15278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.18,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Skn sub grft f/n/hf/g child","code_information":[{"code":"15277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":532.68,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":532.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":543.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Skin sub graft f/n/hf/g addl","code_information":[{"code":"15276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.92,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Skin sub graft face/nk/hf/g","code_information":[{"code":"15275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.22,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":223.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":227.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Skn sub grft t/a/l child add","code_information":[{"code":"15274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.65,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Skin sub grft t/arm/lg child","code_information":[{"code":"15273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":467.42,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":467.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":476.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Skin sub graft t/a/l add-on","code_information":[{"code":"15272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.45,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Skin sub graft trnk/arm/leg","code_information":[{"code":"15271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":200.83,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":204.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Skin full graft add-on","code_information":[{"code":"15261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":321.39,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":321.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":327.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Skin full graft een & lips","code_information":[{"code":"15260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1995.28,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2001.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2041.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Skin full graft add-on","code_information":[{"code":"15241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":255.42,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":255.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":260.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Skin full grft face/genit/hf","code_information":[{"code":"15240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1886.09,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1886.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1923.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Skin full graft add-on","code_information":[{"code":"15221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.7,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Skin full graft sclp/arm/leg","code_information":[{"code":"15220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1447.77,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1447.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1476.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Skin full graft trunk add-on","code_information":[{"code":"15201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.57,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":182.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":186.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Skin full graft trunk","code_information":[{"code":"15200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1603.53,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1603.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1635.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Cult epiderm grft f/n/hfg +%","code_information":[{"code":"15157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.26,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":395.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":403.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cult skin grft f/n/hfg add","code_information":[{"code":"15156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":362.78,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":362.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":369.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cult skin graft f/n/hf/g","code_information":[{"code":"15155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1733.74,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1733.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1767.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Cult skin graft t/a/l +%","code_information":[{"code":"15152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.52,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":333.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":340.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cult skin grft t/a/l addl","code_information":[{"code":"15151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.96,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":262.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":268.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cult skin grft t/arm/leg","code_information":[{"code":"15150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1537.86,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1537.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1568.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Derm autograft f/n/hf/g add","code_information":[{"code":"15136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":212.6,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":212.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":216.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Derm autograft face/nck/hf/g","code_information":[{"code":"15135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1802.63,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1802.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1838.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Derm autograft t/a/l add-on","code_information":[{"code":"15131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":212.6,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":212.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":216.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Derm autograft trnk/arm/leg","code_information":[{"code":"15130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1417.9,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1417.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1445.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Skn splt a-grft f/n/hf/g add","code_information":[{"code":"15121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":312.9,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":312.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":319.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Skn splt a-grft fac/nck/hf/g","code_information":[{"code":"15120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1647.09,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1647.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1679.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Epidrm a-grft f/n/hf/g addl","code_information":[{"code":"15116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":332.34,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":332.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":338.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Epidrm a-grft face/nck/hf/g","code_information":[{"code":"15115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1668.84,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1668.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1701.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Epidrm autogrft t/a/l add-on","code_information":[{"code":"15111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.45,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":249.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Epidrm autogrft trnk/arm/leg","code_information":[{"code":"15110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1713.72,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1713.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1747.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Skin splt grft t/a/l add-on","code_information":[{"code":"15101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.11,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":264.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":269.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Skin splt grft trnk/arm/leg","code_information":[{"code":"15100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1706.4,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1706.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1739.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Skin pinch graft","code_information":[{"code":"15050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":714.71,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1085.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1106.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Harvest cultured skin graft","code_information":[{"code":"15040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.28,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":299.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":305.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Wnd prep f/n/hf/g addl cm","code_information":[{"code":"15005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.69,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":214.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":218.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Wound prep f/n/hf/g","code_information":[{"code":"15004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":618.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":630.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Wound prep addl 100 cm","code_information":[{"code":"15003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.24,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Wound prep trk/arm/leg","code_information":[{"code":"15002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":523.49,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":523.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":533.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Filleted finger/toe flap","code_information":[{"code":"14350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1615.32,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1615.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1647.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Tis trnfr addl 30 sq cm/<","code_information":[{"code":"14302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":514.53,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":514.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":524.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Tis trnfr any 30.1-60 sq cm","code_information":[{"code":"14301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2068.52,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2068.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2109.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Tis trnfr e/n/e/l10.1-30sqcm","code_information":[{"code":"14061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1939.74,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1939.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1977.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Tis trnfr e/n/e/l 10 sq cm/<","code_information":[{"code":"14060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1576.47,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1576.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1607.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Tis trnfr f/c/c/m/n/a/g/h/f","code_information":[{"code":"14041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1807.11,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1807.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1842.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Tis trnfr f/c/c/m/n/a/g/h/f","code_information":[{"code":"14040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1480.08,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1480.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1509.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Tis trnfr s/a/l 10.1-30 sqcm","code_information":[{"code":"14021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1681.35,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1681.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1714.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Tis trnfr s/a/l 10 sq cm/<","code_information":[{"code":"14020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1343.93,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1343.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1370.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Tis trnfr trunk 10.1-30sqcm","code_information":[{"code":"14001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1556.53,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1556.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1587.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Tis trnfr trunk 10 sq cm/<","code_information":[{"code":"14000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1199.0,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1199.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1222.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Late closure of wound","code_information":[{"code":"13160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1902.12,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1902.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1939.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Cmplx rpr e/n/e/l addl 5cm/<","code_information":[{"code":"13153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":325.13,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":325.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":331.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cmplx rpr e/n/e/l 2.6-7.5 cm","code_information":[{"code":"13152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":714.71,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":794.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":810.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cmplx rpr e/n/e/l 1.1-2.5 cm","code_information":[{"code":"13151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":658.71,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":658.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":298.18,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":298.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":304.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":716.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":730.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":573.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":584.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cmplx rpr s/a/l addl 5 cm/>","code_information":[{"code":"13122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.65,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":196.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cmplx rpr s/a/l 2.6-7.5 cm","code_information":[{"code":"13121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":610.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":622.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cmplx rpr s/a/l 1.1-2.5 cm","code_information":[{"code":"13120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":546.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":557.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cmplx rpr trunk addl 5cm/<","code_information":[{"code":"13102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":170.97,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":170.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cmplx rpr trunk 2.6-7.5 cm","code_information":[{"code":"13101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":582.29,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":582.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":593.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cmplx rpr trunk 1.1-2.5 cm","code_information":[{"code":"13100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":474.65,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":474.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":483.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr face/mm >30.0 cm","code_information":[{"code":"12057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":998.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1018.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr face/mm 20.1-30.0","code_information":[{"code":"12056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":913.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":931.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr face/mm 12.6-20 cm","code_information":[{"code":"12055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":720.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":734.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr face/mm 7.6-12.5cm","code_information":[{"code":"12054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":525.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":535.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr face/mm 5.1-7.5 cm","code_information":[{"code":"12053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":510.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":520.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr face/mm 2.6-5.0 cm","code_information":[{"code":"12052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":472.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":481.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr face/mm 2.5 cm/<","code_information":[{"code":"12051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":401.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":409.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr n-hf/genit >30.0cm","code_information":[{"code":"12047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":846.15,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":846.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":862.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Intmd rpr n-hf/genit20.1-30","code_information":[{"code":"12046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":714.71,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":761.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":776.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Intmd rpr n-hf/genit12.6-20","code_information":[{"code":"12045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":651.37,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":651.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":664.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr n-hf/genit7.6-12.5","code_information":[{"code":"12044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":509.77,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":509.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":519.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr n-hf/genit2.6-7.5","code_information":[{"code":"12042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":463.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":472.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr n-hf/genit 2.5cm/<","code_information":[{"code":"12041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":344.49,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":344.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":351.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr s/tr/ext >30.0 cm","code_information":[{"code":"12037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":785.84,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":785.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":801.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Intmd rpr s/a/t/ext 20.1-30","code_information":[{"code":"12036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":675.57,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":675.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":688.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr s/a/t/ext 12.6-20","code_information":[{"code":"12035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":575.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":586.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr s/tr/ext 7.6-12.5","code_information":[{"code":"12034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":487.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":496.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr s/a/t/ext 2.6-7.5","code_information":[{"code":"12032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":449.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":458.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intmd rpr s/a/t/ext 2.5 cm/<","code_information":[{"code":"12031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":357.91,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":357.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":364.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Closure of split wound","code_information":[{"code":"12021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":335.97,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":335.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":342.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Closure of split wound","code_information":[{"code":"12020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":448.61,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":448.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":457.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rpr f/e/e/n/l/m >30.0 cm","code_information":[{"code":"12018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":422.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":431.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rpr fe/e/en/l/m 20.1-30.0 cm","code_information":[{"code":"12017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.51,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":382.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rpr fe/e/en/l/m 12.6-20.0 cm","code_information":[{"code":"12016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":311.03,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":311.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":317.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rpr f/e/e/n/l/m 7.6-12.5 cm","code_information":[{"code":"12015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":229.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":233.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rpr f/e/e/n/l/m 5.1-7.5 cm","code_information":[{"code":"12014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.85,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":182.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":186.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rpr f/e/e/n/l/m 2.6-5.0 cm","code_information":[{"code":"12013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":141.21,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rpr f/e/e/n/l/m 2.5 cm/<","code_information":[{"code":"12011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.56,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":137.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rpr s/n/ax/gen/trnk >30.0 cm","code_information":[{"code":"12007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":349.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":356.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rpr s/n/a/gen/trk20.1-30.0cm","code_information":[{"code":"12006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":281.93,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":281.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":287.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rpr s/n/a/gen/trk12.6-20.0cm","code_information":[{"code":"12005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":230.86,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":230.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":235.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rpr s/n/ax/gen/trk7.6-12.5cm","code_information":[{"code":"12004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":178.59,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":178.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":182.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rpr s/n/ax/gen/trnk2.6-7.5cm","code_information":[{"code":"12002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.67,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rpr s/n/ax/gen/trnk 2.5cm/<","code_information":[{"code":"12001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.35,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Remove/insert drug implant","code_information":[{"code":"11983","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":248.6,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":248.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":253.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":432.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.96,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":626.4,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":561.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Remove drug implant device","code_information":[{"code":"11982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.86,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":175.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":432.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.96,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":626.4,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":561.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Insert drug implant device","code_information":[{"code":"11981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.66,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.66,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.52,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":186.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":167.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Implant hormone pellet(s)","code_information":[{"code":"11980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.4,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":432.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.96,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":626.4,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":561.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Remove contraceptive capsule","code_information":[{"code":"11976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.96,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":223.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":228.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Remove tissue expander(s)","code_information":[{"code":"11971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1317.2,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1317.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1343.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Replace tissue expander","code_information":[{"code":"11970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1341.07,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1341.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1367.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Insert tissue expander(s)","code_information":[{"code":"11960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2400.45,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2400.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2447.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Tx contour defects >10.0 cc","code_information":[{"code":"11954","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.92,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":266.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":272.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Tx contour defects 5.1-10cc","code_information":[{"code":"11952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.42,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":249.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Tx contour defects 1.1-5.0cc","code_information":[{"code":"11951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.8,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":173.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":177.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Tx contour defects 1 cc/<","code_information":[{"code":"11950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.11,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Correct skin color ea 20.0cm","code_information":[{"code":"11922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.05,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Correct skn color 6.1-20.0cm","code_information":[{"code":"11921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":311.14,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":311.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":317.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Correct skin color 6.0 cm/<","code_information":[{"code":"11920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.77,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":270.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":276.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Inject skin lesions >7","code_information":[{"code":"11901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.99,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Inject skin lesions <=w 7","code_information":[{"code":"11900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":71.23,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Remove pilonidal cyst compl","code_information":[{"code":"11772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1384.79,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1384.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1411.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove pilonidal cyst exten","code_information":[{"code":"11771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1080.97,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1080.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1102.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove pilonidal cyst simple","code_information":[{"code":"11770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.83,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":445.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":454.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Excision of nail fold toe","code_information":[{"code":"11765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.87,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":229.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":234.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Reconstruction of nail bed","code_information":[{"code":"11762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":465.74,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":465.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":474.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Repair of nail bed","code_information":[{"code":"11760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":272.39,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":272.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":277.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Biopsy nail unit","code_information":[{"code":"11755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":151.72,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Removal of nail bed","code_information":[{"code":"11750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.33,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":253.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":258.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Drain blood from under nail","code_information":[{"code":"11740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.2,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.66,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.52,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":186.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":167.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Remove nail plate add-on","code_information":[{"code":"11732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.43,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Removal of nail plate","code_information":[{"code":"11730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.42,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":137.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Debride nail 6 or more","code_information":[{"code":"11721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.05,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.05,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.76,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":82.72,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Debride nail 1-5","code_information":[{"code":"11720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.7,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.05,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.76,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":82.72,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Trim nail(s) any number","code_information":[{"code":"11719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.65,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.05,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.76,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":82.72,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Exc f/e/e/n/l mal+mrg >4 cm","code_information":[{"code":"11646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":927.22,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":927.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":945.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc f/e/e/n/l mal+mrg 3.1-4","code_information":[{"code":"11644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":669.27,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":669.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":682.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc f/e/e/n/l mal+mrg 2.1-3","code_information":[{"code":"11643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":539.33,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":539.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":549.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc f/e/e/n/l mal+mrg 1.1-2","code_information":[{"code":"11642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":431.67,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":431.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":440.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc f/e/e/n/l mal+mrg 0.6-1","code_information":[{"code":"11641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":368.39,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":368.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc f/e/e/n/l mal+mrg 0.5cm<","code_information":[{"code":"11640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.3,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":300.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":306.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc s/n/h/f/g mal+mrg >4 cm","code_information":[{"code":"11626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.77,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":707.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc s/n/h/f/g mal+mrg 3.1-4","code_information":[{"code":"11624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":565.4,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":565.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":576.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc s/n/h/f/g mal+mrg 2.1-3","code_information":[{"code":"11623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":495.91,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":505.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc s/n/h/f/g mal+mrg 1.1-2","code_information":[{"code":"11622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":401.12,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":401.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":408.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc s/n/h/f/g mal+mrg 0.6-1","code_information":[{"code":"11621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.35,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":353.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":360.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc h-f-nk-sp mal+marg 0.5/<","code_information":[{"code":"11620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":292.79,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":292.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":298.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc tr-ext mal+marg >4 cm","code_information":[{"code":"11606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":755.56,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":755.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":770.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc tr-ext mal+marg 3.1-4 cm","code_information":[{"code":"11604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":504.05,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":504.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":513.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc tr-ext mal+marg 2.1-3 cm","code_information":[{"code":"11603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":457.16,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":457.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":466.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc tr-ext mal+marg 1.1-2 cm","code_information":[{"code":"11602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":381.67,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":381.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":389.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Exc tr-ext mal+marg 0.6-1 cm","code_information":[{"code":"11601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":351.67,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":351.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":358.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc tr-ext mal+marg 0.5 cm/<","code_information":[{"code":"11600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":290.37,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":290.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":296.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":842.08,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":842.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":858.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":686.73,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":686.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":700.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":797.42,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":797.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":813.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":596.26,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":596.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":607.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":794.06,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":794.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":809.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":626.97,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":626.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":639.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc face-mm b9+marg >4 cm","code_information":[{"code":"11446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":757.3,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":757.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":772.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc face-mm b9+marg 3.1-4 cm","code_information":[{"code":"11444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":537.43,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":537.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":547.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc face-mm b9+marg 2.1-3 cm","code_information":[{"code":"11443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":425.67,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":425.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":434.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc face-mm b9+marg 1.1-2 cm","code_information":[{"code":"11442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":348.62,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":348.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":355.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc face-mm b9+marg 0.6-1 cm","code_information":[{"code":"11441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.7,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":315.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":321.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc face-mm b9+marg 0.5 cm/<","code_information":[{"code":"11440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":251.98,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":251.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":256.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc h-f-nk-sp b9+marg >4 cm","code_information":[{"code":"11426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":641.25,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":641.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":653.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc h-f-nk-sp b9+marg 3.1-4","code_information":[{"code":"11424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":431.7,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":431.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":440.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc h-f-nk-sp b9+marg 2.1-3","code_information":[{"code":"11423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":373.59,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":373.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":380.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc h-f-nk-sp b9+marg 1.1-2","code_information":[{"code":"11422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.16,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":322.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":328.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc h-f-nk-sp b9+marg 0.6-1","code_information":[{"code":"11421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":259.41,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":259.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":264.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc h-f-nk-sp b9+marg 0.5/<","code_information":[{"code":"11420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.7,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":198.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc tr-ext b9+marg >4.0 cm","code_information":[{"code":"11406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":594.61,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":594.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":606.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc tr-ext b9+marg 3.1-4 cm","code_information":[{"code":"11404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":392.01,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":392.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":399.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc tr-ext b9+marg 2.1-3cm/<","code_information":[{"code":"11403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.44,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":355.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":362.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc tr-ext b9+marg 1.1-2 cm","code_information":[{"code":"11402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.48,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":274.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":279.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc tr-ext b9+marg 0.6-1 cm","code_information":[{"code":"11401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":250.42,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":250.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":255.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Exc tr-ext b9+marg 0.5 cm<","code_information":[{"code":"11400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":199.18,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":199.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.14,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":228.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":232.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":176.06,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.89,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":148.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.1,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.37,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":170.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.86,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":148.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.77,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":89.87,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":168.93,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":168.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":172.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":141.65,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.69,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.91,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Remove skin tags add-on","code_information":[{"code":"11201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.45,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Removal of skin tags <w/15","code_information":[{"code":"11200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":180.29,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Incal bx skn ea sep/addl","code_information":[{"code":"11107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.96,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Incal bx skn single les","code_information":[{"code":"11106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.81,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":137.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Punch bx skin ea sep/addl","code_information":[{"code":"11105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.94,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Punch bx skin single lesion","code_information":[{"code":"11104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":111.43,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Tangntl bx skin ea sep/addl","code_information":[{"code":"11103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.98,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Tangntl bx skin single les","code_information":[{"code":"11102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":89.6,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Trim skin lesions over 4","code_information":[{"code":"11057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.05,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Trim skin lesions 2 to 4","code_information":[{"code":"11056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.86,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Trim skin lesion","code_information":[{"code":"11055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.4,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Deb bone add-on","code_information":[{"code":"11047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":232.87,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":232.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Deb musc/fascia add-on","code_information":[{"code":"11046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.81,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Deb subq tissue add-on","code_information":[{"code":"11045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.75,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Deb bone 20 sq cm/<","code_information":[{"code":"11044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":541.06,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":541.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":551.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Deb musc/fascia 20 sq cm/<","code_information":[{"code":"11043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":367.57,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":367.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":374.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Deb subq tissue 20 sq cm/<","code_information":[{"code":"11042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.57,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Deb skin bone at fx site","code_information":[{"code":"11012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":994.51,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":994.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1014.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Debride skin musc at fx site","code_information":[{"code":"11011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":684.79,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":712.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":726.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Debride skin at fx site","code_information":[{"code":"11010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":658.1,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":658.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Remove mesh from abd wall","code_information":[{"code":"11008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.46,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":655.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":668.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Debride genit/per/abdom wall","code_information":[{"code":"11006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1682.53,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1682.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1715.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Debride abdom wall","code_information":[{"code":"11005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1861.28,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1861.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1897.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Debride genitalia & perineum","code_information":[{"code":"11004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1364.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1364.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1390.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Debride infected skin add-on","code_information":[{"code":"11001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.53,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Debride infected skin","code_information":[{"code":"11000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.44,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Complex drainage wound","code_information":[{"code":"10180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":426.53,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":426.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":434.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Puncture drainage of lesion","code_information":[{"code":"10160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.19,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":229.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":233.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Drainage of hematoma/fluid","code_information":[{"code":"10140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":281.63,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":281.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":287.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove foreign body","code_information":[{"code":"10121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":438.41,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":438.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":447.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove foreign body","code_information":[{"code":"10120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.87,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":249.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":254.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Drainage of pilonidal cyst","code_information":[{"code":"10081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":409.59,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":409.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":417.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Drainage of pilonidal cyst","code_information":[{"code":"10080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.62,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":249.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":254.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Drainage of skin abscess","code_information":[{"code":"10061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":438.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":447.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Drainage of skin abscess","code_information":[{"code":"10060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":251.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":256.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Acne surgery","code_information":[{"code":"10040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.03,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Perq dev soft tiss add imag","code_information":[{"code":"10036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.06,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Perq dev soft tiss 1st imag","code_information":[{"code":"10035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":199.57,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":199.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Guide cathet fluid drainage","code_information":[{"code":"10030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":321.26,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":321.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":327.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Fna w/o image","code_information":[{"code":"10021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.29,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Fna bx w/mr gdn ea addl","code_information":[{"code":"10012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":440.14,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":440.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":448.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Fna bx w/mr gdn 1st les","code_information":[{"code":"10011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":684.79,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":823.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":840.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Fna bx w/ct gdn ea addl","code_information":[{"code":"10010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.08,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":177.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Fna bx w/ct gdn 1st les","code_information":[{"code":"10009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":258.97,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":258.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":264.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Fna bx w/fluor gdn ea addl","code_information":[{"code":"10008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.25,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Fna bx w/fluor gdn 1st les","code_information":[{"code":"10007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.39,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":214.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":218.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Fna bx w/us gdn ea addl","code_information":[{"code":"10006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":119.41,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Fna bx w/us gdn 1st les","code_information":[{"code":"10005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.43,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":177.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Fna bx w/o img gdn ea addl","code_information":[{"code":"10004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":104.01,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Suction lipectomy trunk","code_information":[{"code":"15877","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1420.16,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1420.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1448.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Suction lipectomy upr extrem","code_information":[{"code":"15878","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1995.28,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4084.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4164.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Suction lipectomy lwr extrem","code_information":[{"code":"15879","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3426.93,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3789.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3863.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of tail bone ulcer","code_information":[{"code":"15920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1509.56,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1509.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1539.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Removal of tail bone ulcer","code_information":[{"code":"15922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1898.11,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1898.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1935.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1692.65,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1692.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1725.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2087.42,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2087.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2128.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15934","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2348.83,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2348.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2394.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2751.49,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2751.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2805.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1995.28,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2152.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2194.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1995.28,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2479.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2528.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.76,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1701.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1735.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2212.24,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2212.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2255.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15944","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2224.75,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2224.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2268.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1995.28,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2430.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2478.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1995.28,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3853.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3929.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1515.64,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1515.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1545.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2138.13,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2138.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2180.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1995.28,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2183.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2225.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2404.02,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2404.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2451.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1995.28,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2837.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2893.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15958","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2805.39,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2805.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2860.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Initial treatment of burn(s)","code_information":[{"code":"16000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.0,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Dress/debrid p-thick burn s","code_information":[{"code":"16020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.5,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Dress/debrid p-thick burn m","code_information":[{"code":"16025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":266.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Dress/debrid p-thick burn l","code_information":[{"code":"16030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.95,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":315.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":322.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Incision of burn scab initi","code_information":[{"code":"16035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":471.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":480.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Escharotomy addl incision","code_information":[{"code":"16036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.19,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":198.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":202.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Destruct premalg lesion","code_information":[{"code":"17000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.66,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruct premalg les 2-14","code_information":[{"code":"17003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.79,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destroy premal lesions 15/>","code_information":[{"code":"17004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":232.95,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":232.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":655.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":667.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":714.71,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":851.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":868.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1255.62,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1255.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1280.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Destruct b9 lesion 1-14","code_information":[{"code":"17110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":161.21,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruct lesion 15 or more","code_information":[{"code":"17111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":196.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Chemical cautery tissue","code_information":[{"code":"17250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":89.29,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.17,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":170.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":206.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":210.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":262.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":267.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":290.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":295.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":310.17,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":310.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":316.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":363.8,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":363.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":370.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":226.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":231.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":249.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":254.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":287.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":293.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":325.33,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":325.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":331.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":397.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":405.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":479.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":489.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":206.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":210.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":280.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":286.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":323.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":330.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.12,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":405.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":413.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.12,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.91,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":570.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":511.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":471.96,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":471.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":481.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":641.77,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":641.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":654.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Mohs 1 stage h/n/hf/g","code_information":[{"code":"17311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":714.71,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":841.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":858.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Mohs Addl Stage","code_information":[{"code":"17312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":448.03,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":448.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":456.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Mohs 1 stage t/a/l","code_information":[{"code":"17313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":714.71,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":755.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":769.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Mohs addl stage t/a/l","code_information":[{"code":"17314","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":415.2,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":415.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":423.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Mohs surg addl block","code_information":[{"code":"17315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.36,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cryotherapy of skin","code_information":[{"code":"17340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.05,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.05,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.76,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":82.72,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Skin peel therapy","code_information":[{"code":"17360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":221.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":226.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Hair removal by electrolysis","code_information":[{"code":"17380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.29,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":188.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":191.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Drainage of breast lesion","code_information":[{"code":"19000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.09,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Drain breast lesion add-on","code_information":[{"code":"19001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.11,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Incision of breast lesion","code_information":[{"code":"19020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":751.96,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":751.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":766.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Injection for breast x-ray","code_information":[{"code":"19030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":180.1,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Bx breast 1st lesion strtctc","code_information":[{"code":"19081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":386.95,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":386.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":394.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Bx breast add lesion strtctc","code_information":[{"code":"19082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.93,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":193.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":197.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Bx breast 1st lesion us imag","code_information":[{"code":"19083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":366.05,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":366.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":373.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Bx breast add lesion us imag","code_information":[{"code":"19084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.6,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":182.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":186.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Bx breast 1st lesion mr imag","code_information":[{"code":"19085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.79,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":424.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":433.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Bx breast add lesion mr imag","code_information":[{"code":"19086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.59,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":211.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":215.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Bx breast percut w/o image","code_information":[{"code":"19100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.04,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":170.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Biopsy of breast open","code_information":[{"code":"19101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":537.49,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":537.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":548.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Cryosurg ablate fa each","code_information":[{"code":"19105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":507.18,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":507.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":517.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Nipple exploration","code_information":[{"code":"19110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":847.08,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":863.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Excise breast duct fistula","code_information":[{"code":"19112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":774.81,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":774.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":790.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of breast lesion","code_information":[{"code":"19120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1008.37,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1008.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1028.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Excision breast lesion","code_information":[{"code":"19125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1116.8,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1116.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1138.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Excision addl breast lesion","code_information":[{"code":"19126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":386.93,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":386.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":394.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Perq device breast 1st imag","code_information":[{"code":"19281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":233.39,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":233.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Perq device breast ea imag","code_information":[{"code":"19282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":117.07,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Perq dev breast 1st strtctc","code_information":[{"code":"19283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":235.92,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":235.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":240.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Perq dev breast add strtctc","code_information":[{"code":"19284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.03,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Perq dev breast 1st us imag","code_information":[{"code":"19285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":199.57,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":199.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Perq dev breast add us imag","code_information":[{"code":"19286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.21,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Perq dev breast 1st mr guide","code_information":[{"code":"19287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":297.96,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":297.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":303.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Perq dev breast add mr guide","code_information":[{"code":"19288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.58,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":148.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Prep tum cav iort prtl mast","code_information":[{"code":"19294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.55,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":396.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":404.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Place po breast cath for rad","code_information":[{"code":"19296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":506.99,"maximum":15887.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":506.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":516.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15887.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7904.01,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8141.13,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11460.81,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10275.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Place breast cath for rad","code_information":[{"code":"19297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.24,"maximum":15887.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":226.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":230.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15887.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Place breast rad tube/caths","code_information":[{"code":"19298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":755.95,"maximum":19323.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":755.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":770.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13326.75,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13726.56,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19323.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17324.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Removal of Breast Tissue","code_information":[{"code":"19300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1032.35,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1032.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1052.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Partial Mastectomy","code_information":[{"code":"19301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.83,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1595.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1627.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"P-Mastectomy w/LN Removal","code_information":[{"code":"19302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2191.64,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2191.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2234.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6421.32,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6613.96,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9310.91,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8347.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Mast simple complete","code_information":[{"code":"19303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2315.45,"maximum":17980.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2315.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2360.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17980.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6421.32,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6613.96,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9310.91,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8347.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Mast radical","code_information":[{"code":"19305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2771.37,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2771.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2825.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Mast rad urban type","code_information":[{"code":"19306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2941.76,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2941.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2999.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Mast mod rad","code_information":[{"code":"19307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2845.81,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2845.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2901.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6421.32,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6613.96,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9310.91,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8347.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Suspension of breast","code_information":[{"code":"19316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1894.01,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1894.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1931.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6421.32,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6613.96,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9310.91,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8347.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Reduction of large breast","code_information":[{"code":"19318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2611.73,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2611.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2663.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6421.32,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6613.96,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9310.91,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8347.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Enlarge breast with implant","code_information":[{"code":"19325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1467.73,"maximum":15887.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1467.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1496.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15887.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7904.01,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8141.13,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11460.81,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10275.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Removal of breast implant","code_information":[{"code":"19328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1322.97,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1322.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1348.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of implant material","code_information":[{"code":"19330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1543.74,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1543.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1574.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Immediate breast prosthesis","code_information":[{"code":"19340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1814.04,"maximum":11460.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1814.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1849.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7904.01,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8141.13,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11460.81,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10275.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Delayed breast prosthesis","code_information":[{"code":"19342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1817.45,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1817.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1853.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7904.01,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8141.13,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11460.81,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10275.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1606.74,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1606.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1638.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Correct inverted nipple(s)","code_information":[{"code":"19355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1473.51,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1473.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1502.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2756.99,"maximum":19323.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2756.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2811.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13326.75,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13726.56,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":19323.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17324.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Breast reconstr w/lat flap","code_information":[{"code":"19361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3718.63,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3718.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3791.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6489.48,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6489.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6616.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4223.4,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4223.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4306.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5175.86,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5175.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5277.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4808.29,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4808.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4902.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Surgery of breast capsule","code_information":[{"code":"19370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1604.27,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1604.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1635.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of breast capsule","code_information":[{"code":"19371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1700.27,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1700.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1733.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revise breast reconstruction","code_information":[{"code":"19380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1927.37,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1927.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1965.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6421.32,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6613.96,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9310.91,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8347.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Design custom breast implant","code_information":[{"code":"19396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.42,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":340.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":347.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3786.39,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3899.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5490.26,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4922.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Explore wound neck","code_information":[{"code":"20100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":521.55,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1609.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1641.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":521.55,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":537.2,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":756.25,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":678.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Explore wound chest","code_information":[{"code":"20101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":560.97,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":560.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":571.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Explore wound abdomen","code_information":[{"code":"20102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":686.24,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":686.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":699.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Explore wound extremity","code_information":[{"code":"20103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":920.65,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":920.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":938.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Excise epiphyseal bar","code_information":[{"code":"20150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2679.27,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2679.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2731.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Muscle biopsy","code_information":[{"code":"20200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":254.54,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":254.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":259.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Deep muscle biopsy","code_information":[{"code":"20205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":415.14,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":415.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":423.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Needle biopsy muscle","code_information":[{"code":"20206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.12,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Bone biopsy trocar/needle","code_information":[{"code":"20220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":229.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":234.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Bone biopsy trocar/needle","code_information":[{"code":"20225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.48,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":340.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":347.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Bone biopsy open superficial","code_information":[{"code":"20240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":373.2,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":373.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":380.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Bone biopsy open deep","code_information":[{"code":"20245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":915.39,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":915.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":933.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Open bone biopsy","code_information":[{"code":"20250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1046.07,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1066.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Open bone biopsy","code_information":[{"code":"20251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1119.33,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1119.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1141.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Injection of sinus tract","code_information":[{"code":"20500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.45,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":236.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":241.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Inject sinus tract for x-ray","code_information":[{"code":"20501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":96.2,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Removal of foreign body","code_information":[{"code":"20520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":391.49,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":391.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":399.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Removal of foreign body","code_information":[{"code":"20525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":657.5,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":657.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":670.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Ther injection carp tunnel","code_information":[{"code":"20526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":151.33,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.83,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":430.41,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":385.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Inj dupuytren cord w/enzyme","code_information":[{"code":"20527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":177.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.83,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":430.41,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":385.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Inj tendon sheath/ligament","code_information":[{"code":"20550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.95,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.83,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":430.41,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":385.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Inj tendon origin/insertion","code_information":[{"code":"20551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.02,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.83,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":430.41,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":385.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Inj trigger point 1/2 muscl","code_information":[{"code":"20552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.01,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.83,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":430.41,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":385.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Inject trigger points 3/>","code_information":[{"code":"20553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":111.35,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.83,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":430.41,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":385.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Place ndl musc/tis for rt","code_information":[{"code":"20555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.06,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":905.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Ndl insj w/o njx 1 or 2 musc","code_information":[{"code":"20560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.97,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.97,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.81,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":40.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Ndl insj w/o njx 3+ musc","code_information":[{"code":"20561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.97,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.97,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.81,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":40.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.62,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.83,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":430.41,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":385.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.77,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.83,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":430.41,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":385.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.29,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.83,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":430.41,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":385.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.85,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":682.62,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":703.09,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":989.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":887.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.3,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.83,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":430.41,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":385.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.41,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":157.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.83,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":430.41,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":385.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Aspirate/inj ganglion cyst","code_information":[{"code":"20612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.4,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.83,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":430.41,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":385.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of bone cyst","code_information":[{"code":"20615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":431.17,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":431.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":439.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Insert and remove bone pin","code_information":[{"code":"20650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":444.68,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":444.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Apply rem fixation device","code_information":[{"code":"20660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":647.32,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":647.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":660.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Application of head brace","code_information":[{"code":"20661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1402.91,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1402.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1430.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Application of pelvis brace","code_information":[{"code":"20662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1394.22,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1394.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1421.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Application of thigh brace","code_information":[{"code":"20663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1286.89,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1312.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Application of halo","code_information":[{"code":"20664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2399.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2446.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Removal of fixation device","code_information":[{"code":"20665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.48,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":257.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":262.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":432.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.96,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":626.4,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":561.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Removal of support implant","code_information":[{"code":"20670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.86,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":382.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":390.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Removal of support implant","code_information":[{"code":"20680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1120.32,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1120.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1142.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Apply bone fixation device","code_information":[{"code":"20690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.17,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1595.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1626.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Apply bone fixation device","code_information":[{"code":"20692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3007.59,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3007.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3066.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Adjust bone fixation device","code_information":[{"code":"20693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1193.25,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1193.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1216.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove bone fixation device","code_information":[{"code":"20694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":912.53,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":912.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":930.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Comp multiplane ext fixation","code_information":[{"code":"20696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3103.4,"maximum":38047.60,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3103.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3164.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26239.73,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27026.92,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":38047.6,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34111.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Comp ext fixate strut change","code_information":[{"code":"20697","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4428.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4515.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Mnl prep&insj dp rx dlvr dev","code_information":[{"code":"20700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.61,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":225.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":230.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rmvl deep rx delivery device","code_information":[{"code":"20701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":170.94,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":170.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Mnl prep&insj imed rx dev","code_information":[{"code":"20702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":379.42,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":379.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":386.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rmvl imed rx delivery device","code_information":[{"code":"20703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":277.31,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":277.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":282.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Mnl prep&insj i-artic rx dev","code_information":[{"code":"20704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":398.92,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":398.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":406.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Rmvl i-artic rx delivery dev","code_information":[{"code":"20705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":330.03,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":330.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":336.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Replantation arm complete","code_information":[{"code":"20802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7300.67,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7300.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7444.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Replant forearm complete","code_information":[{"code":"20805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8674.9,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8674.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8845.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Replantation hand complete","code_information":[{"code":"20808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10470.49,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10470.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10676.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Replantation digit complete","code_information":[{"code":"20816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5466.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5573.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Replantation digit complete","code_information":[{"code":"20822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4718.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4811.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Replantation thumb complete","code_information":[{"code":"20824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5476.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5583.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Replantation thumb complete","code_information":[{"code":"20827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4844.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4939.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Replantation foot complete","code_information":[{"code":"20838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7405.09,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7405.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7550.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Removal of bone for graft","code_information":[{"code":"20900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":479.52,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":479.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":488.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of bone for graft","code_information":[{"code":"20902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":732.3,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":732.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":746.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove cartilage for graft","code_information":[{"code":"20910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":714.71,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1271.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1296.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.71,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.15,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":1036.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":929.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Remove cartilage for graft","code_information":[{"code":"20912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.0,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1284.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1309.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3529.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4969.05,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4455.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of fascia for graft","code_information":[{"code":"20920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1065.38,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1065.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1086.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Removal of fascia for graft","code_information":[{"code":"20922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1334.08,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1334.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1360.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of tendon for graft","code_information":[{"code":"20924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1345.85,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1345.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1372.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Sp bone algrft morsel add-on","code_information":[{"code":"20930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":308.91,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":308.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":314.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Sp bone algrft struct add-on","code_information":[{"code":"20931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.53,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":296.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":302.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Osteoart algrft w/surf & b1","code_information":[{"code":"20932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2006.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2045.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Hemicrt intrclry algrft prtl","code_information":[{"code":"20933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1840.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1876.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intercalary algrft compl","code_information":[{"code":"20934","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2004.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2044.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Sp bone agrft local add-on","code_information":[{"code":"20936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":330.14,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":330.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":336.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Sp bone agrft morsel add-on","code_information":[{"code":"20937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":446.96,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":446.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":455.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Sp bone agrft struct add-on","code_information":[{"code":"20938","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":493.38,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":493.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":503.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Bone marrow aspir bone grfg","code_information":[{"code":"20939","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":186.7,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":186.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":190.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Fluid pressure muscle","code_information":[{"code":"20950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.55,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":234.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":239.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Fibula bone graft microvasc","code_information":[{"code":"20955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6486.98,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6486.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6614.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Iliac bone graft microvasc","code_information":[{"code":"20956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7017.06,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7021.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7159.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Mt bone graft microvasc","code_information":[{"code":"20957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7017.06,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7313.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7456.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Other bone graft microvasc","code_information":[{"code":"20962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7017.06,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7092.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7231.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Bone/skin graft microvasc","code_information":[{"code":"20969","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7017.06,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7211.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7353.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Bone/skin graft iliac crest","code_information":[{"code":"20970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7017.06,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7575.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7724.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Bone/skin graft metatarsal","code_information":[{"code":"20972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7017.06,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7553.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7702.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Bone/skin graft great toe","code_information":[{"code":"20973","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7017.06,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7980.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8137.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Electrical bone stimulation","code_information":[{"code":"20974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.6,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":137.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":70.47,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Electrical bone stimulation","code_information":[{"code":"20975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":469.92,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":469.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":479.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Us bone stimulation","code_information":[{"code":"20979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.97,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.97,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.81,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":40.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Ablate bone tumor(s) perq","code_information":[{"code":"20982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.58,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":971.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":990.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Ablate bone tumor(s) perq","code_information":[{"code":"20983","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":903.71,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":903.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":921.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Cptr-asst dir ms px","code_information":[{"code":"20985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":384.64,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":384.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":392.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Incision of jaw joint","code_information":[{"code":"21010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1954.95,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1954.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1993.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc face les sc <2 cm","code_information":[{"code":"21011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":689.7,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":689.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":703.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc face les sbq 2 cm/>","code_information":[{"code":"21012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":904.53,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":904.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":922.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc face tum deep < 2 cm","code_information":[{"code":"21013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1069.78,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1069.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1090.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc face tum deep 2 cm/>","code_information":[{"code":"21014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1389.11,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1389.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1416.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Resect face/scalp tum < 2 cm","code_information":[{"code":"21015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1853.61,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1853.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1890.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect face/scalp tum 2 cm/>","code_information":[{"code":"21016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2683.42,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2683.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2736.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Excision of bone lower jaw","code_information":[{"code":"21025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1752.58,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1752.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1786.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Excision of facial bone(s)","code_information":[{"code":"21026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1129.65,"maximum":8300.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1129.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1151.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Contour of face bone lesion","code_information":[{"code":"21029","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1657.18,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1657.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1689.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Excise max/zygoma b9 tumor","code_information":[{"code":"21030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":949.36,"maximum":8300.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":949.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":968.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove exostosis mandible","code_information":[{"code":"21031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":714.51,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":714.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":728.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove exostosis maxilla","code_information":[{"code":"21032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":685.77,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":685.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":699.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Excise max/zygoma mal tumor","code_information":[{"code":"21034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2986.5,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2986.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3045.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Excise mandible lesion","code_information":[{"code":"21040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":952.68,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":952.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":971.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of jaw bone lesion","code_information":[{"code":"21044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2288.55,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2288.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2333.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Extensive jaw surgery","code_information":[{"code":"21045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3181.2,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3181.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3243.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Remove mandible cyst complex","code_information":[{"code":"21046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2598.26,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2598.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2649.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Excise lwr jaw cyst w/repair","code_information":[{"code":"21047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3209.83,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3209.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Remove maxilla cyst complex","code_information":[{"code":"21048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2624.44,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2624.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2675.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruction of lower jaw","code_information":[{"code":"21244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2651.33,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2651.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2703.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruction of jaw","code_information":[{"code":"21245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2480.34,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2480.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2529.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruction of jaw","code_information":[{"code":"21246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2234.98,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2234.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2278.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct lower jaw bone","code_information":[{"code":"21247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4153.46,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4153.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4235.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruction of jaw","code_information":[{"code":"21248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2097.51,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2097.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2138.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruction of jaw","code_information":[{"code":"21249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2937.14,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2937.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2994.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct lower jaw bone","code_information":[{"code":"21255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3494.73,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3494.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3563.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruction of orbit","code_information":[{"code":"21256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3285.98,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3285.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3350.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3601.1,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3601.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3671.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5724.72,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6397.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6522.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5724.72,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5914.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6030.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4208.27,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4208.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4290.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5291.66,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5291.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5395.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Augmentation cheek bone","code_information":[{"code":"21270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1984.02,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1984.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2022.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision orbitofacial bones","code_information":[{"code":"21275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2235.75,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2235.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2279.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of eyelid","code_information":[{"code":"21280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1542.42,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1542.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1572.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of eyelid","code_information":[{"code":"21282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1046.43,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1066.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Revision of jaw muscle/bone","code_information":[{"code":"21295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":519.7,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":519.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":529.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Revision of jaw muscle/bone","code_information":[{"code":"21296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1077.51,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1077.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1098.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Closed tx nose fx w/o stablj","code_information":[{"code":"21315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":158.9,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":158.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":162.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Closed tx nose fx w/ stablj","code_information":[{"code":"21320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.3,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":253.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":258.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Open tx nose fx uncomplicatd","code_information":[{"code":"21325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1162.4,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1162.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1185.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Open tx nose fx w/skele fixj","code_information":[{"code":"21330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1404.32,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1404.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1431.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Open tx nose & septal fx","code_information":[{"code":"21335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1893.32,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1893.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1930.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Open tx septal fx w/wo stabj","code_information":[{"code":"21336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1669.88,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1669.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1702.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Closed tx septal&nose fx","code_information":[{"code":"21337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":795.63,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":795.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":811.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Open nasoethmoid fx w/o fixj","code_information":[{"code":"21338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1755.24,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1755.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1789.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Open nasoethmoid fx w/ fixj","code_information":[{"code":"21339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1988.64,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1988.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2027.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Perq tx nasoethmoid fx","code_information":[{"code":"21340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2008.63,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2008.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2048.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Open tx dprsd front sinus fx","code_information":[{"code":"21343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2871.99,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2871.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2928.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Open tx compl front sinus fx","code_information":[{"code":"21344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.1,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3700.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3772.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Closed tx nose/jaw fx","code_information":[{"code":"21345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1500.45,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1706.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1739.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Opn tx nasomax fx w/fixj","code_information":[{"code":"21346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2674.62,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2674.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2727.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Opn tx nasomax fx multple","code_information":[{"code":"21347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2734.22,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2734.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2787.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Opn tx nasomax fx w/graft","code_information":[{"code":"21348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2918.3,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2918.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2975.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Perq tx malar fracture","code_information":[{"code":"21355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":874.83,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":874.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":892.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Opn tx dprsd zygomatic arch","code_information":[{"code":"21356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1066.81,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1066.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1087.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Opn tx dprsd malar fracture","code_information":[{"code":"21360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1398.87,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1398.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1426.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Opn tx complx malar fx","code_information":[{"code":"21365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2866.27,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2866.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2922.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Opn tx complx malar w/grft","code_information":[{"code":"21366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3382.25,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3382.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3448.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Opn tx orbit fx transantral","code_information":[{"code":"21385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1937.29,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1937.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1975.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Opn tx orbit fx periorbital","code_information":[{"code":"21386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1836.37,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1836.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1872.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Opn tx orbit fx combined","code_information":[{"code":"21387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2022.85,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2022.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2062.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Opn tx orbit periorbtl implt","code_information":[{"code":"21390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2121.6,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2121.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2163.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Opn tx orbit periorbt w/grft","code_information":[{"code":"21395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2671.02,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2671.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2723.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Closed tx orbit w/o manipulj","code_information":[{"code":"21400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":447.21,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":447.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":455.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":521.55,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":537.2,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":756.25,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":678.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Closed tx orbit w/manipulj","code_information":[{"code":"21401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":873.18,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":873.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":890.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Opn tx orbit fx w/o implant","code_information":[{"code":"21406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1545.97,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1545.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1576.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Opn tx orbit fx w/implant","code_information":[{"code":"21407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1697.6,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1697.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1730.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Opn tx orbit fx w/bone grft","code_information":[{"code":"21408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2392.01,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2392.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2438.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat mouth roof fracture","code_information":[{"code":"21421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.89,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1418.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1446.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat mouth roof fracture","code_information":[{"code":"21422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1648.27,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1648.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1680.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat mouth roof fracture","code_information":[{"code":"21423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2108.12,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2108.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2149.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1804.94,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1804.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1840.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1876.35,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1876.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1913.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4593.13,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4593.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4683.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3727.71,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3727.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3800.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5395.69,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5395.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5501.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat dental ridge fracture","code_information":[{"code":"21440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1552.32,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1552.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1582.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat dental ridge fracture","code_information":[{"code":"21445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1633.06,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1633.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1665.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":521.55,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1236.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1261.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":521.55,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":537.2,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":756.25,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":678.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1500.45,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1654.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1687.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1168.06,"maximum":8300.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1168.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1191.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2393.44,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2393.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2440.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1294.62,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1294.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1320.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2752.17,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2752.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2806.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3007.87,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3007.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3066.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2116.57,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2116.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2158.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3086.57,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3086.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3147.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reset dislocated jaw","code_information":[{"code":"21480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.88,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Reset dislocated jaw","code_information":[{"code":"21485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1500.45,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2001.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2040.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Repair dislocated jaw","code_information":[{"code":"21490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2086.73,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2086.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2127.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Interdental wiring","code_information":[{"code":"21497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1500.45,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1513.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1543.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Drain neck/chest lesion","code_information":[{"code":"21501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":896.36,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":896.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":913.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Drain chest lesion","code_information":[{"code":"21502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1358.91,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1358.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1385.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"21510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1208.43,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1208.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1232.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Biopsy of neck/chest","code_information":[{"code":"21550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":412.61,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":412.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":420.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc neck les sc 3 cm/>","code_information":[{"code":"21552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1200.57,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1200.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1224.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc neck tum deep 5 cm/>","code_information":[{"code":"21554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1960.37,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1960.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1998.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc neck les sc < 3 cm","code_information":[{"code":"21555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.22,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":820.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":836.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc neck tum deep < 5 cm","code_information":[{"code":"21556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1416.8,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1416.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1444.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Resect neck thorax tumor<5cm","code_information":[{"code":"21557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2563.99,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2563.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2614.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect neck tumor 5 cm/>","code_information":[{"code":"21558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2808.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3584.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3654.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Partial removal of rib","code_information":[{"code":"21600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1510.6,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1510.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1540.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Exc chest wall tumor w/ribs","code_information":[{"code":"21601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2808.98,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3068.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3128.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc ch wal tum w/o lymphadec","code_information":[{"code":"21602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4067.91,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4067.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4147.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Exc ch wal tum w/lymphadec","code_information":[{"code":"21603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4469.11,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4469.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4556.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Partial removal of rib","code_information":[{"code":"21610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3164.16,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3278.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3342.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of rib","code_information":[{"code":"21615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1670.19,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1670.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1702.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Removal of rib and nerves","code_information":[{"code":"21616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1916.64,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1916.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1954.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Partial removal of sternum","code_information":[{"code":"21620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1342.77,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1342.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1369.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Sternal debridement","code_information":[{"code":"21627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1457.67,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1457.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1486.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Extensive sternum surgery","code_information":[{"code":"21630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3484.11,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3484.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3552.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Hyoid myotomy & suspension","code_information":[{"code":"21685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2617.67,"maximum":8300.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2617.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2669.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":955.41,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":955.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":974.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Revision of neck muscle/rib","code_information":[{"code":"21705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1430.08,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1430.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1437.54,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1437.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1465.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":684.79,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1454.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1483.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Reconstruction of sternum","code_information":[{"code":"21740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2742.63,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2742.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2796.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair stern/nuss w/o scope","code_information":[{"code":"21742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3164.16,"maximum":13768.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3216.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3279.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair sternum/nuss w/scope","code_information":[{"code":"21743","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3164.16,"maximum":13768.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4232.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4315.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair of sternum separation","code_information":[{"code":"21750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1806.86,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1806.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1842.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Optx of rib fx w/fixj scope","code_information":[{"code":"21811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1589.45,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1620.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treatment of rib fracture","code_information":[{"code":"21812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1917.55,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1917.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1955.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treatment of rib fracture","code_information":[{"code":"21813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2629.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2680.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat sternum fracture","code_information":[{"code":"21820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":398.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":406.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat sternum fracture","code_information":[{"code":"21825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1474.55,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1474.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1503.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Biopsy soft tissue of back","code_information":[{"code":"21920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":410.33,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":410.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":418.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Biopsy soft tissue of back","code_information":[{"code":"21925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1010.98,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1010.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1030.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc back les sc < 3 cm","code_information":[{"code":"21930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":977.98,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":977.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":997.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc back les sc 3 cm/>","code_information":[{"code":"21931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1261.89,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1261.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc back tum deep < 5 cm","code_information":[{"code":"21932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1776.01,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1776.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1810.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc back tum deep 5 cm/>","code_information":[{"code":"21933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1978.79,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1978.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2017.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Resect back tum < 5 cm","code_information":[{"code":"21935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2736.47,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2736.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2790.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect back tum 5 cm/>","code_information":[{"code":"21936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2808.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3790.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3865.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"I&d p-spine c/t/cerv-thor","code_information":[{"code":"22010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2612.61,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2612.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2663.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"I&d abscess p-spine l/s/ls","code_information":[{"code":"22015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2547.19,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2547.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2597.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Remove part of neck vertebra","code_information":[{"code":"22100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2556.46,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2556.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2606.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Remove part thorax vertebra","code_information":[{"code":"22101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2356.5,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2356.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2402.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Remove part lumbar vertebra","code_information":[{"code":"22102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2063.13,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2063.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2103.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Remove extra spine segment","code_information":[{"code":"22103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":359.95,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":359.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":367.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Remove part of neck vertebra","code_information":[{"code":"22110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2856.54,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2856.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2912.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Remove part thorax vertebra","code_information":[{"code":"22112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3082.89,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3082.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3143.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Remove part lumbar vertebra","code_information":[{"code":"22114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3082.89,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3082.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3143.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Remove extra spine segment","code_information":[{"code":"22116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":378.37,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":378.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":385.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Incis spine 3 column thorac","code_information":[{"code":"22206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6610.92,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6610.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6740.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incis spine 3 column lumbar","code_information":[{"code":"22207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6462.64,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6462.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6589.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incis spine 3 column adl seg","code_information":[{"code":"22208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1584.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1615.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Incis 1 vertebral seg cerv","code_information":[{"code":"22210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4819.98,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4819.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4914.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incis 1 vertebral seg thorac","code_information":[{"code":"22212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4068.85,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4068.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4148.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incis 1 vertebral seg lumbar","code_information":[{"code":"22214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4070.5,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4070.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4150.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incis addl spine segment","code_information":[{"code":"22216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":970.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":989.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Incis w/discectomy cervical","code_information":[{"code":"22220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4354.41,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4354.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4439.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incis w/discectomy thoracic","code_information":[{"code":"22222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4782.22,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4782.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4876.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incis w/discectomy lumbar","code_information":[{"code":"22224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4240.31,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4240.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4323.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revise extra spine segment","code_information":[{"code":"22226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":960.08,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":960.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":978.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Closed tx vert fx w/o manj","code_information":[{"code":"22310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":795.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":811.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Closed tx vert fx w/manj","code_information":[{"code":"22315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2086.15,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2086.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2127.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat odontoid fx w/o graft","code_information":[{"code":"22318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4491.44,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4491.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4579.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat odontoid fx w/graft","code_information":[{"code":"22319","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4986.11,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4986.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5084.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat spine fracture","code_information":[{"code":"22325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3986.48,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3986.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4064.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat neck spine fracture","code_information":[{"code":"22326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.48,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4088.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4168.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Excis uppr jaw cyst w/repair","code_information":[{"code":"21049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3053.05,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3053.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3113.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Removal of jaw joint","code_information":[{"code":"21050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2266.0,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2266.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2310.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Remove jaw joint cartilage","code_information":[{"code":"21060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2057.77,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2057.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2098.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Remove coronoid process","code_information":[{"code":"21070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1623.63,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1623.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Mnpj of tmj w/anesth","code_information":[{"code":"21073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":633.74,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":633.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":646.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1500.45,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1881.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1918.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4634.08,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4634.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4725.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.15,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3112.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3173.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3206.19,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3510.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3579.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3221.68,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3221.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3284.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2969.34,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2969.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3027.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2744.5,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2744.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2798.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3177.02,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3177.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3239.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.04,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1289.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1314.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.04,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":235.92,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":332.11,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":297.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3206.19,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3415.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3482.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3415.03,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3415.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3482.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3206.19,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9084.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9262.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Maxillofacial fixation","code_information":[{"code":"21100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":937.53,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":937.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":955.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Interdental fixation","code_information":[{"code":"21110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1500.45,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1833.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1869.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Injection jaw joint x-ray","code_information":[{"code":"21116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":117.56,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1328.91,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1328.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1355.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1397.96,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1397.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1425.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1966.14,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1966.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2004.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2213.75,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2213.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2257.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Augmentation lower jaw bone","code_information":[{"code":"21125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1768.53,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1768.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1803.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Augmentation lower jaw bone","code_information":[{"code":"21127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2048.59,"maximum":13768.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2048.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2088.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reduction of forehead","code_information":[{"code":"21137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1989.96,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1989.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2029.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Reduction of forehead","code_information":[{"code":"21138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2423.82,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2423.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2471.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reduction of forehead","code_information":[{"code":"21139","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2880.27,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2880.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2936.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lefort i-1 piece w/o graft","code_information":[{"code":"21141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3496.79,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3496.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3565.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lefort i-2 piece w/o graft","code_information":[{"code":"21142","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3590.18,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3590.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3660.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lefort i-3/> piece w/o graft","code_information":[{"code":"21143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3701.58,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3701.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3774.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lefort i-1 piece w/ graft","code_information":[{"code":"21145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4072.7,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4072.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4152.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lefort i-2 piece w/ graft","code_information":[{"code":"21146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4252.44,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4252.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4335.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lefort i-3/> piece w/ graft","code_information":[{"code":"21147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4475.76,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4475.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4563.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lefort ii anterior intrusion","code_information":[{"code":"21150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4361.67,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4361.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4447.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lefort ii w/bone grafts","code_information":[{"code":"21151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4803.59,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4803.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4897.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lefort iii w/o lefort i","code_information":[{"code":"21154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5171.02,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5171.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5272.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lefort iii w/ lefort i","code_information":[{"code":"21155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5724.72,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5740.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5852.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lefort iii w/fhdw/o lefort i","code_information":[{"code":"21159","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5724.72,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6881.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7016.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lefort iii w/fhd w/ lefort i","code_information":[{"code":"21160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5724.72,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7465.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7612.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct orbit/forehead","code_information":[{"code":"21172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5724.72,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5727.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5839.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct orbit/forehead","code_information":[{"code":"21175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5724.72,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5847.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5962.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct entire forehead","code_information":[{"code":"21179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4024.9,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4024.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4103.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct entire forehead","code_information":[{"code":"21180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4494.9,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4494.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4583.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Contour cranial bone lesion","code_information":[{"code":"21181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1964.55,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1964.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2003.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Reconstruct cranial bone","code_information":[{"code":"21182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5602.41,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5602.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5712.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct cranial bone","code_information":[{"code":"21183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5724.72,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6095.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6215.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct cranial bone","code_information":[{"code":"21184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5724.72,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6558.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6687.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruction of midface","code_information":[{"code":"21188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4138.75,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4138.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4220.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconst lwr jaw w/o graft","code_information":[{"code":"21193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3236.09,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3236.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3299.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconst lwr jaw w/graft","code_information":[{"code":"21194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3740.22,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3740.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3813.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconst lwr jaw w/o fixation","code_information":[{"code":"21195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3508.95,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3508.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3577.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconst lwr jaw w/fixation","code_information":[{"code":"21196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3751.17,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3751.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3824.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstr lwr jaw segment","code_information":[{"code":"21198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2667.58,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2667.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2719.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Reconstr Lwr Jaw W/Advance","code_information":[{"code":"21199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2683.18,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2683.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2735.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct upper jaw bone","code_information":[{"code":"21206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2562.62,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2562.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2612.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Augmentation of facial bones","code_information":[{"code":"21208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1947.83,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1947.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1986.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reduction of facial bones","code_information":[{"code":"21209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1591.56,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1591.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1622.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Face bone graft","code_information":[{"code":"21210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2004.56,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2004.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2043.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lower jaw bone graft","code_information":[{"code":"21215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2083.73,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2083.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2124.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Rib cartilage graft","code_information":[{"code":"21230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1986.74,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1986.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2025.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Ear cartilage graft","code_information":[{"code":"21235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1510.66,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1510.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1540.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Reconstruction of jaw joint","code_information":[{"code":"21240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2758.64,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2758.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2812.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruction of jaw joint","code_information":[{"code":"21242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2658.37,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2658.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2710.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruction of jaw joint","code_information":[{"code":"21243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4401.73,"maximum":38047.60,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4401.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4488.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26239.73,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27026.92,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":38047.6,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34111.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Resect shoulder tumor 5 cm/>","code_information":[{"code":"23078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2808.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3838.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3914.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Biopsy of shoulder joint","code_information":[{"code":"23100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1359.9,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1359.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1386.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Shoulder joint surgery","code_information":[{"code":"23101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1231.67,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1231.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1255.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove shoulder joint lining","code_information":[{"code":"23105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1720.32,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1720.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1754.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Incision of collarbone joint","code_information":[{"code":"23106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1349.1,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1349.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1375.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Explore treat shoulder joint","code_information":[{"code":"23107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1782.74,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1782.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1817.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Partial removal collar bone","code_information":[{"code":"23120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.14,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1578.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1609.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of collar bone","code_information":[{"code":"23125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1904.68,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1904.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1942.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove shoulder bone part","code_information":[{"code":"23130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1656.35,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1656.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1688.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1492.23,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1492.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1521.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.07,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1866.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1902.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1674.81,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1674.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1707.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1790.09,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1790.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1825.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2135.68,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2135.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2177.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1821.35,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1821.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1857.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove collar bone lesion","code_information":[{"code":"23170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1517.37,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1517.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1547.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove shoulder blade lesion","code_information":[{"code":"23172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1532.58,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1532.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1562.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"23174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2048.06,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2048.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2088.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove collar bone lesion","code_information":[{"code":"23180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1772.24,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1772.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1807.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove shoulder blade lesion","code_information":[{"code":"23182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1800.32,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1800.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1835.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"23184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1985.42,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1985.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2024.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Partial removal of scapula","code_information":[{"code":"23190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1544.95,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1544.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1575.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of head of humerus","code_information":[{"code":"23195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2002.83,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2002.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2042.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Resect clavicle tumor","code_information":[{"code":"23200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4010.74,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4010.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Resect scapula tumor","code_information":[{"code":"23210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4706.82,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4706.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4799.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Resect prox humerus tumor","code_information":[{"code":"23220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5153.09,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5153.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5254.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Remove shoulder foreign body","code_information":[{"code":"23330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.97,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":445.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":454.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Remove shoulder fb deep","code_information":[{"code":"23333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1271.0,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1271.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1295.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Shoulder prosthesis removal","code_information":[{"code":"23334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2825.65,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2825.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2881.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Shoulder prosthesis removal","code_information":[{"code":"23335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3379.92,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3379.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3446.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Injection for shoulder x-ray","code_information":[{"code":"23350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.86,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Muscle transfer shoulder/arm","code_information":[{"code":"23395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3424.93,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3424.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3492.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Muscle transfers","code_information":[{"code":"23397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3048.21,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3048.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3108.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Fixation of shoulder blade","code_information":[{"code":"23400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2599.93,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2599.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2650.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Incision of tendon & muscle","code_information":[{"code":"23405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1647.17,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1647.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1679.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Incise tendon(s) & muscle(s)","code_information":[{"code":"23406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1953.96,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1953.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1992.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair rotator cuff acute","code_information":[{"code":"23410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2191.42,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2191.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2234.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair rotator cuff chronic","code_information":[{"code":"23412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2278.9,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2278.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2323.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Release of shoulder ligament","code_information":[{"code":"23415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1869.04,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1869.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1905.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair of shoulder","code_information":[{"code":"23420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2603.76,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2603.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2654.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair biceps tendon","code_information":[{"code":"23430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1992.51,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1992.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2031.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Remove/transplant tendon","code_information":[{"code":"23440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2029.91,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2029.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2069.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2528.87,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2528.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2578.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2636.92,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2636.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2688.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2913.21,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2913.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2970.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2852.99,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2852.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2909.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2987.46,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2987.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3046.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2997.45,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2997.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3056.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct shoulder joint","code_information":[{"code":"23470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3195.91,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3195.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3258.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Reconstruct shoulder joint","code_information":[{"code":"23472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3850.99,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3850.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3926.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Revis reconst shoulder joint","code_information":[{"code":"23473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4285.71,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4285.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4369.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revis reconst shoulder joint","code_information":[{"code":"23474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4628.25,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4628.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4719.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of collar bone","code_information":[{"code":"23480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2196.15,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2196.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2239.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of collar bone","code_information":[{"code":"23485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2550.6,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2600.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Reinforce clavicle","code_information":[{"code":"23490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2303.57,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2303.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2348.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Reinforce shoulder bones","code_information":[{"code":"23491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2714.53,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2714.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2767.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":621.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":633.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":909.59,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":909.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":927.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1929.32,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1929.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1967.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":649.36,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":649.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":662.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":984.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1003.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1545.86,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1545.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1576.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1681.85,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1681.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1714.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":644.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":656.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":880.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":898.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1535.57,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1535.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1565.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1741.3,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1741.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1775.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat shoulder blade fx","code_information":[{"code":"23570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":659.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":672.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat shoulder blade fx","code_information":[{"code":"23575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1030.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1050.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat scapula fracture","code_information":[{"code":"23585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2607.3,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2607.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2658.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":857.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":874.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1158.74,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1158.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1181.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2361.92,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2361.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2408.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3301.18,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3301.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3366.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":706.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":719.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":961.07,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":961.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":979.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2091.21,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2091.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2132.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":820.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":836.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1100.39,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1100.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1121.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1570.69,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1570.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1087.87,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1087.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1109.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2335.27,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2335.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2381.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1359.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1386.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2462.41,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2462.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2510.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fixation of shoulder","code_information":[{"code":"23700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":523.55,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":523.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":533.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Fusion of shoulder joint","code_information":[{"code":"23800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2745.0,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2745.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2798.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fusion of shoulder joint","code_information":[{"code":"23802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3424.0,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3424.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3491.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation of arm & girdle","code_information":[{"code":"23900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3693.28,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3765.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation at shoulder joint","code_information":[{"code":"23920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3000.14,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3000.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3059.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"23921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1266.71,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1266.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1291.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Drainage of arm lesion","code_information":[{"code":"23930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":575.96,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":575.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":587.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Drainage of arm bursa","code_information":[{"code":"23931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":429.19,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":429.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":437.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Drain arm/elbow bone lesion","code_information":[{"code":"23935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1378.77,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1378.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1405.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exploratory elbow surgery","code_information":[{"code":"24000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1286.53,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1311.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Release elbow joint","code_information":[{"code":"24006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1913.56,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1913.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1951.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Biopsy arm/elbow soft tissue","code_information":[{"code":"24065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":432.05,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":432.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":440.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Revision of wrist joint","code_information":[{"code":"25450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1659.52,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1659.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1692.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of wrist joint","code_information":[{"code":"25455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1958.61,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1958.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1997.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reinforce radius","code_information":[{"code":"25490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1928.88,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1928.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1966.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reinforce ulna","code_information":[{"code":"25491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1983.33,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1983.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2022.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reinforce radius and ulna","code_information":[{"code":"25492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2426.55,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2426.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2474.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":703.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":716.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1252.05,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1252.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1276.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1799.85,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1799.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1835.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1472.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1501.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2117.53,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2117.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2159.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2559.98,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2559.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2610.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat fracture of ulna","code_information":[{"code":"25530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":661.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":674.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat fracture of ulna","code_information":[{"code":"25535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1239.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1264.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat fracture of ulna","code_information":[{"code":"25545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1676.59,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1676.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1709.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":706.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":720.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1262.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1287.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1810.93,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1810.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1846.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2419.26,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2419.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2466.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":877.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":894.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1384.49,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1384.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1411.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Treat Fx Distal Radial","code_information":[{"code":"25606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1794.38,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1794.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1829.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Biopsy arm/elbow soft tissue","code_information":[{"code":"24066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1133.03,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1133.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1155.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc arm/elbow les sc 3 cm/>","code_information":[{"code":"24071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1088.26,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1088.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1109.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Ex arm/elbow tum deep 5 cm/>","code_information":[{"code":"24073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1857.13,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1857.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1893.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc arm/elbow les sc < 3 cm","code_information":[{"code":"24075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":882.7,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":882.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":900.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Ex arm/elbow tum deep < 5 cm","code_information":[{"code":"24076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1465.34,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1465.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1494.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect arm/elbow tum < 5 cm","code_information":[{"code":"24077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2751.24,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2751.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2805.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect arm/elbow tum 5 cm/>","code_information":[{"code":"24079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2808.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3546.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3616.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Biopsy elbow joint lining","code_information":[{"code":"24100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1131.43,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1131.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1153.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Explore/treat elbow joint","code_information":[{"code":"24101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1350.99,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1350.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1377.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove elbow joint lining","code_information":[{"code":"24102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1656.3,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1656.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1688.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of elbow bursa","code_information":[{"code":"24105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":966.52,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":966.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":985.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"24110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1586.09,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1617.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1977.97,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1977.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2016.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2303.62,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2303.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2348.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove elbow lesion","code_information":[{"code":"24120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1430.8,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1430.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1672.88,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1672.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1705.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1746.2,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1746.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1780.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of head of radius","code_information":[{"code":"24130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1371.15,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1371.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1398.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of arm bone lesion","code_information":[{"code":"24134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2004.04,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2004.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2043.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove radius bone lesion","code_information":[{"code":"24136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1697.96,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1697.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1731.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove elbow bone lesion","code_information":[{"code":"24138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1841.62,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1841.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1877.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Partial removal of arm bone","code_information":[{"code":"24140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1883.53,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1883.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1920.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Partial removal of radius","code_information":[{"code":"24145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1596.87,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1596.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1628.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Partial removal of elbow","code_information":[{"code":"24147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1681.3,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1681.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1714.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Radical resection of elbow","code_information":[{"code":"24149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3151.58,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3151.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3213.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Resect distal humerus tumor","code_information":[{"code":"24150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4117.14,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4117.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4197.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Resect radius tumor","code_information":[{"code":"24152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3583.09,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3583.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3653.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Removal of elbow joint","code_information":[{"code":"24155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2280.36,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2280.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2325.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove elbow joint implant","code_information":[{"code":"24160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3164.16,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3353.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3419.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove radius head implant","code_information":[{"code":"24164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1943.32,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1943.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1981.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of arm foreign body","code_information":[{"code":"24200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":377.03,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":377.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":384.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Removal of arm foreign body","code_information":[{"code":"24201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1072.36,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1072.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1093.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Injection for elbow x-ray","code_information":[{"code":"24220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.59,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":175.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Manipulate elbow w/anesth","code_information":[{"code":"24300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1174.61,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1174.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1197.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Muscle/tendon transfer","code_information":[{"code":"24301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2011.05,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2011.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2050.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Arm tendon lengthening","code_information":[{"code":"24305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1556.01,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1556.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revision of arm tendon","code_information":[{"code":"24310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1274.85,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1274.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1299.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair of arm tendon","code_information":[{"code":"24320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2090.63,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2090.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2131.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revision of arm muscles","code_information":[{"code":"24330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1926.13,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1926.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of arm muscles","code_information":[{"code":"24331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2104.11,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2104.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2145.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Tenolysis triceps","code_information":[{"code":"24332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1652.94,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1652.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1685.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair of biceps tendon","code_information":[{"code":"24340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1602.51,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1602.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1633.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair arm tendon/muscle","code_information":[{"code":"24341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2006.02,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2006.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2045.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair of ruptured tendon","code_information":[{"code":"24342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2072.73,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2072.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2113.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repr elbow lat ligmnt w/tiss","code_information":[{"code":"24343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1913.42,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1913.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1951.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Reconstruct elbow lat ligmnt","code_information":[{"code":"24344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2951.93,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2951.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3009.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6354.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat thorax spine fracture","code_information":[{"code":"22327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4156.68,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4156.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4238.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat each add spine fx","code_information":[{"code":"22328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":757.08,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":757.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":771.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Manipulation of spine","code_information":[{"code":"22505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":347.88,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":347.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":354.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Perq cervicothoracic inject","code_information":[{"code":"22510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1147.14,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1147.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1169.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Perq lumbosacral injection","code_information":[{"code":"22511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1079.07,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1079.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1100.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Vertebroplasty addl inject","code_information":[{"code":"22512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":551.84,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":551.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":562.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Perq vertebral augmentation","code_information":[{"code":"22513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1357.1,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1357.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1383.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Perq vertebral augmentation","code_information":[{"code":"22514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1264.37,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1264.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1289.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Perq vertebral augmentation","code_information":[{"code":"22515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":579.4,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":579.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":590.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Idet single level","code_information":[{"code":"22526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":869.83,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":869.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":886.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Idet 1 or more levels","code_information":[{"code":"22527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":405.08,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":405.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":413.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Lat thorax spine fusion","code_information":[{"code":"22532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4837.33,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4837.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4932.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Lat lumbar spine fusion","code_information":[{"code":"22533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4458.41,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4458.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4545.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Lat thor/lumb addl seg","code_information":[{"code":"22534","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":967.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":986.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5344.21,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5344.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5449.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Neck spine fuse&remov bel c2","code_information":[{"code":"22551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4591.48,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4591.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4681.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Addl neck spine fusion","code_information":[{"code":"22552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1064.97,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1064.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1085.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3406.98,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3406.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3473.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Thorax spine fusion","code_information":[{"code":"22556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4545.92,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4545.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4635.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Lumbar spine fusion","code_information":[{"code":"22558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4104.79,"maximum":38047.60,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4104.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4185.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26239.73,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27026.92,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":38047.6,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34111.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Additional spinal fusion","code_information":[{"code":"22585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":871.15,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":871.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Prescrl fuse w/ instr l5-s1","code_information":[{"code":"22586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5528.71,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5528.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5637.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Spine & skull spinal fusion","code_information":[{"code":"22590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4306.94,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4306.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4391.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Neck spinal fusion","code_information":[{"code":"22595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4115.16,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4115.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4195.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3520.83,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3520.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3589.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Thorax spine fusion","code_information":[{"code":"22610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3457.47,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3457.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3525.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Lumbar spine fusion","code_information":[{"code":"22612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4252.35,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4252.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4335.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Spine fusion extra segment","code_information":[{"code":"22614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1051.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1071.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Lumbar spine fusion","code_information":[{"code":"22630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4220.32,"maximum":38047.60,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4220.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4303.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26239.73,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27026.92,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":38047.6,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34111.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Spine fusion extra segment","code_information":[{"code":"22632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":865.32,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":865.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":882.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Lumbar spine fusion combined","code_information":[{"code":"22633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4873.5,"maximum":38047.60,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4873.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4969.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26239.73,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27026.92,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":38047.6,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34111.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17286.0}]}]},{"description":"Spine fusion extra segment","code_information":[{"code":"22634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1302.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1327.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Post fusion <=6 vert seg","code_information":[{"code":"22800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3673.56,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3673.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3745.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Post fusion 7-12 vert seg","code_information":[{"code":"22802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5694.21,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5694.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5806.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Post fusion 13/> vert seg","code_information":[{"code":"22804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6536.15,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6536.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6664.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Ant fusion 2-3 vert seg","code_information":[{"code":"22808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4927.92,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4927.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5024.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Ant fusion 4-7 vert seg","code_information":[{"code":"22810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5352.13,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5352.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5457.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Ant fusion 8/> vert seg","code_information":[{"code":"22812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5862.92,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5862.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5978.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Kyphectomy 1-2 segments","code_information":[{"code":"22818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5730.37,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5730.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5842.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Kyphectomy 3 or more","code_information":[{"code":"22819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6594.53,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6594.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6724.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Exploration of spinal fusion","code_information":[{"code":"22830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2215.68,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2215.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2259.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Ant thrc vrt body tethrg <7","code_information":[{"code":"22836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4580.54,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4580.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4670.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Ant thrc vrt body tethrg 8+","code_information":[{"code":"22837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5047.43,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5047.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5146.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Rev rplc/rmv thrc vrt tethrg","code_information":[{"code":"22838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5114.73,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5114.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5215.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2029.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2069.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1036.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1056.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2049.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2089.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2194.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2238.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2633.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2685.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1951.92,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1951.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1990.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2032.0,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2032.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2071.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22847","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2122.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2164.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Insert pelv fixation device","code_information":[{"code":"22848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":963.88,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":963.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":982.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Reinsert spinal fixation","code_information":[{"code":"22849","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3517.28,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3517.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3586.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1979.53,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1979.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2018.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.68,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1907.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1945.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Insj biomechanical device","code_information":[{"code":"22853","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":691.71,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":691.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":705.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Insj biomechanical device","code_information":[{"code":"22854","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":901.67,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":901.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":919.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2988.29,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2988.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3046.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Cerv artific diskectomy","code_information":[{"code":"22856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4376.21,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4376.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4462.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Lumbar Artif Diskectomy","code_information":[{"code":"22857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4655.17,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4655.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4746.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Second level cer diskectomy","code_information":[{"code":"22858","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1356.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1383.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Insj biomechanical device","code_information":[{"code":"22859","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":894.85,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":894.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":912.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Tot disc arthrp 2ntrspc lmbr","code_information":[{"code":"22860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":918.78,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":918.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":936.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Revise cerv artific disc","code_information":[{"code":"22861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6305.42,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6305.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6429.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Revise Lumbar Artif Disc","code_information":[{"code":"22862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6300.31,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6300.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6424.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Remove cerv artif disc","code_information":[{"code":"22864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5628.45,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5628.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5738.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Remove Lumb Artif Disc","code_information":[{"code":"22865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6147.96,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6147.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6268.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Insj stablj dev w/dcmprn","code_information":[{"code":"22867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2882.61,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2882.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2939.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Insj stablj dev w/dcmprn","code_information":[{"code":"22868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":651.59,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":651.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":664.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Insj stablj dev w/o dcmprn","code_information":[{"code":"22869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1150.05,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1150.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1172.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Insj stablj dev w/o dcmprn","code_information":[{"code":"22870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":312.68,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":312.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":318.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Exc abdl tum deep < 5 cm","code_information":[{"code":"22900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1519.76,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1519.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1549.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc abdl tum deep 5 cm/>","code_information":[{"code":"22901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1789.67,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1789.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1824.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc abd les sc < 3 cm","code_information":[{"code":"22902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":895.13,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":895.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":912.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc abd les sc 3 cm/>","code_information":[{"code":"22903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1182.78,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1182.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1206.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Radical resect abd tumor<5cm","code_information":[{"code":"22904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2808.98,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2809.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2864.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Rad resect abd tumor 5 cm/>","code_information":[{"code":"22905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2808.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3564.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3634.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of calcium deposits","code_information":[{"code":"23000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.88,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":957.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":976.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Release shoulder joint","code_information":[{"code":"23020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1848.52,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1848.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1884.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Drain shoulder lesion","code_information":[{"code":"23030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":680.71,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":680.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Drain shoulder bursa","code_information":[{"code":"23031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":593.67,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":593.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":605.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Drain shoulder bone lesion","code_information":[{"code":"23035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1814.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1849.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exploratory shoulder surgery","code_information":[{"code":"23040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1920.02,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1920.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1957.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Exploratory shoulder surgery","code_information":[{"code":"23044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1516.57,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1516.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1546.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Biopsy shoulder tissues","code_information":[{"code":"23065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":425.43,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":425.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":433.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Biopsy shoulder tissues","code_information":[{"code":"23066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":985.88,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":985.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1005.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc shoulder les sc 3 cm/>","code_information":[{"code":"23071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1127.67,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1127.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1149.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc shoulder tum deep 5 cm/>","code_information":[{"code":"23073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1867.5,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1867.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1904.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc shoulder les sc < 3 cm","code_information":[{"code":"23075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":881.73,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":881.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":899.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc shoulder tum deep < 5 cm","code_information":[{"code":"23076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1455.52,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1455.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1484.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect shoulder tumor < 5 cm","code_information":[{"code":"23077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2808.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3030.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3090.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Decompress forearm 2 spaces","code_information":[{"code":"25024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2087.75,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2087.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2128.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Decompress forearm 2 spaces","code_information":[{"code":"25025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3276.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3340.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Drainage of forearm lesion","code_information":[{"code":"25028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1807.36,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1807.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1842.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Drainage of forearm bursa","code_information":[{"code":"25031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":991.05,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":991.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1010.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat forearm bone lesion","code_information":[{"code":"25035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1583.56,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1583.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1614.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Explore/treat wrist joint","code_information":[{"code":"25040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1500.1,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1500.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1529.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Biopsy forearm soft tissues","code_information":[{"code":"25065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":418.61,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":418.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":426.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Biopsy forearm soft tissues","code_information":[{"code":"25066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":984.64,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":984.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1003.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc forearm les sc 3 cm/>","code_information":[{"code":"25071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1138.94,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1138.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1161.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc forearm tum deep 3 cm/>","code_information":[{"code":"25073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1436.33,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1436.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1464.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc forearm les sc < 3 cm","code_information":[{"code":"25075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.85,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":845.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":862.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc forearm tum deep < 3 cm","code_information":[{"code":"25076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1390.48,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1390.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1417.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect forearm/wrist tum<3cm","code_information":[{"code":"25077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2307.42,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2307.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2352.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect forarm/wrist tum 3cm>","code_information":[{"code":"25078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2808.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3120.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3181.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of wrist capsule","code_information":[{"code":"25085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1207.06,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1207.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1230.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Biopsy of wrist joint","code_information":[{"code":"25100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":941.74,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":941.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":960.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Explore/treat wrist joint","code_information":[{"code":"25101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1092.38,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1092.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1113.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove wrist joint lining","code_information":[{"code":"25105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1308.73,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1308.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1334.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove wrist joint cartilage","code_information":[{"code":"25107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1656.63,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1656.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1689.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Excise tendon forearm/wrist","code_information":[{"code":"25109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1439.54,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1439.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1467.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove wrist tendon lesion","code_information":[{"code":"25110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":930.49,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":930.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":948.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove wrist tendon lesion","code_information":[{"code":"25111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":873.62,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":873.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":890.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Reremove wrist tendon lesion","code_information":[{"code":"25112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1052.15,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1052.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1072.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove wrist/forearm lesion","code_information":[{"code":"25115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2026.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2066.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove wrist/forearm lesion","code_information":[{"code":"25116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1621.18,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1621.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1653.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Excise wrist tendon sheath","code_information":[{"code":"25118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1030.29,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1030.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1050.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1349.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1349.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1376.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of forearm lesion","code_information":[{"code":"25120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1348.02,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1348.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1374.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove/graft forearm lesion","code_information":[{"code":"25125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1600.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1631.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove/graft forearm lesion","code_information":[{"code":"25126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1612.02,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1612.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1643.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of wrist lesion","code_information":[{"code":"25130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1212.31,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1212.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1236.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove & graft wrist lesion","code_information":[{"code":"25135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1509.31,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1509.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1538.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove & graft wrist lesion","code_information":[{"code":"25136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1338.34,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1338.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1364.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove forearm bone lesion","code_information":[{"code":"25145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1401.81,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1401.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1429.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1521.52,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1521.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1551.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Partial removal of radius","code_information":[{"code":"25151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1568.27,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1568.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1599.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Resect radius/ulnar tumor","code_information":[{"code":"25170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3913.09,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3913.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3989.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of wrist bone","code_information":[{"code":"25210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1325.5,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1325.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1351.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of wrist bones","code_information":[{"code":"25215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.16,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1662.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1694.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Partial removal of radius","code_information":[{"code":"25230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1165.12,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1165.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1188.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1157.94,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1157.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1180.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Injection for wrist x-ray","code_information":[{"code":"25246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.63,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":193.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":197.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Remove forearm foreign body","code_information":[{"code":"25248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1141.77,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1141.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1164.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of wrist prosthesis","code_information":[{"code":"25250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1435.01,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1435.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1463.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Removal of wrist prosthesis","code_information":[{"code":"25251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1930.67,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1930.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1968.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Manipulate wrist w/anesthes","code_information":[{"code":"25259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1155.3,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1155.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1177.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1700.55,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1700.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1733.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.87,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1701.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1735.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2020.34,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2020.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2060.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1327.92,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1327.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1354.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1505.68,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1505.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1535.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1781.64,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1781.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1816.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair forearm tendon sheath","code_information":[{"code":"25275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1802.49,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1802.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1837.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revise wrist/forearm tendon","code_information":[{"code":"25280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1520.23,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1520.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1550.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Incise wrist/forearm tendon","code_information":[{"code":"25290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1173.21,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1173.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1196.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Release wrist/forearm tendon","code_information":[{"code":"25295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1414.9,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1414.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1442.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Fusion of tendons at wrist","code_information":[{"code":"25300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1851.25,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1851.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1887.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Fusion of tendons at wrist","code_information":[{"code":"25301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1726.86,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1726.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1760.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Transplant forearm tendon","code_information":[{"code":"25310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1666.45,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1666.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1699.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Transplant forearm tendon","code_information":[{"code":"25312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1922.2,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1922.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1959.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise palsy hand tendon(s)","code_information":[{"code":"25315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2063.93,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2063.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2104.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revise palsy hand tendon(s)","code_information":[{"code":"25316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2452.42,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2452.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2500.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair/revise wrist joint","code_information":[{"code":"25320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2643.55,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2643.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2695.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise wrist joint","code_information":[{"code":"25332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2261.16,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2261.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2305.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Realignment of hand","code_information":[{"code":"25335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2525.79,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2525.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2575.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct ulna/radioulnar","code_information":[{"code":"25337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2373.42,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2373.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2420.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of radius","code_information":[{"code":"25350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1807.85,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1807.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1843.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of radius","code_information":[{"code":"25355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2051.42,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2051.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2091.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of ulna","code_information":[{"code":"25360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1760.8,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1760.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1795.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise radius & ulna","code_information":[{"code":"25365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2454.18,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2454.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2502.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise radius or ulna","code_information":[{"code":"25370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2704.82,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2704.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2757.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise radius & ulna","code_information":[{"code":"25375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2550.79,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2600.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Shorten radius or ulna","code_information":[{"code":"25390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2057.91,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2057.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2098.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lengthen radius or ulna","code_information":[{"code":"25391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2662.55,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2662.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2714.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Shorten radius & ulna","code_information":[{"code":"25392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2709.03,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2709.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2762.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Lengthen radius & ulna","code_information":[{"code":"25393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3016.94,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3016.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3076.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair carpal bone shorten","code_information":[{"code":"25394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2103.06,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2103.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2144.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair radius or ulna","code_information":[{"code":"25400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2146.87,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2146.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2189.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair/graft radius or ulna","code_information":[{"code":"25405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2768.12,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2768.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2822.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair radius & ulna","code_information":[{"code":"25415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2588.3,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2588.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2639.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair/graft radius & ulna","code_information":[{"code":"25420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3115.26,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3115.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair/graft radius or ulna","code_information":[{"code":"25425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2576.7,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2576.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2627.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair/graft radius & ulna","code_information":[{"code":"25426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2999.87,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2999.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3058.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Vasc graft into carpal bone","code_information":[{"code":"25430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1962.79,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1962.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2001.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair nonunion carpal bone","code_information":[{"code":"25431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2111.84,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2111.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2153.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair/graft wrist bone","code_information":[{"code":"25440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2058.71,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2058.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2099.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2509.76,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2509.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2559.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2163.98,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2163.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2206.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2105.35,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2105.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2146.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2200.44,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2200.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2243.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1930.42,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1930.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1968.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Wrist replacement","code_information":[{"code":"25446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3128.87,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3128.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3190.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Repair wrist joints","code_information":[{"code":"25447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2225.85,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2225.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2269.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Arthrp ntrcrpl/crp/mtcrp ssp","code_information":[{"code":"25448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2317.34,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2317.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2362.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove wrist joint implant","code_information":[{"code":"25449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2757.37,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2757.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2811.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat Fx Rad Extra-Articul","code_information":[{"code":"25607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1983.47,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1983.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2022.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat Fx Rad Intra-Articul","code_information":[{"code":"25608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2218.56,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2218.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2262.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat Fx Radial 3+ Frag","code_information":[{"code":"25609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2811.79,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2811.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2867.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":772.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":787.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1205.77,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1205.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1229.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1926.16,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1926.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":774.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":789.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1147.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1169.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.1,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1536.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1566.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":832.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":848.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Pin ulnar styloid fracture","code_information":[{"code":"25651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1320.22,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1320.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1346.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat fracture ulnar styloid","code_information":[{"code":"25652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1672.91,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1672.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1705.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1213.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1237.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1631.44,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1631.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1663.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Pin radioulnar dislocation","code_information":[{"code":"25671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1440.15,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1440.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1122.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1145.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1693.01,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1693.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1726.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat wrist fracture","code_information":[{"code":"25680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1430.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat wrist fracture","code_information":[{"code":"25685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.6,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1972.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2011.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1329.24,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1329.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1355.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1704.2,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1704.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1737.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Fusion of wrist joint","code_information":[{"code":"25800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1957.09,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1957.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1995.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fusion/graft of wrist joint","code_information":[{"code":"25805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2269.85,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2269.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2314.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fusion/graft of wrist joint","code_information":[{"code":"25810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2319.19,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2319.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2364.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fusion of hand bones","code_information":[{"code":"25820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1729.12,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1729.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1763.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Fuse hand bones with graft","code_information":[{"code":"25825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2112.39,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2112.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2153.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fusion radioulnar jnt/ulna","code_information":[{"code":"25830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2717.19,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2717.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2770.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1920.0,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1920.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1957.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1883.31,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1883.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1920.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1651.51,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1651.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1683.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1837.61,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1837.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1873.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3117.68,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3117.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3178.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputate hand at wrist","code_information":[{"code":"25920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1946.4,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1984.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputate hand at wrist","code_information":[{"code":"25922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1723.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1757.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1901.63,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1901.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1938.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation of hand","code_information":[{"code":"25927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2278.18,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2278.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2322.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1608.61,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1608.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1640.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2106.34,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2106.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2147.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Drainage of finger abscess","code_information":[{"code":"26010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.02,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":374.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":381.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":281.33,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Drainage of finger abscess","code_information":[{"code":"26011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.33,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":492.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":502.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Drain hand tendon sheath","code_information":[{"code":"26020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1488.88,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1488.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1518.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Drainage of palm bursa","code_information":[{"code":"26025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1123.43,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1123.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1145.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Drainage of palm bursas","code_information":[{"code":"26030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1318.68,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1318.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1344.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat hand bone lesion","code_information":[{"code":"26034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1475.76,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1475.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1504.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Decompress fingers/hand","code_information":[{"code":"26035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2303.68,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2303.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2348.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Decompress fingers/hand","code_information":[{"code":"26037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1506.62,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1506.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1536.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Release palm contracture","code_information":[{"code":"26040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":849.26,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":849.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":865.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Release palm contracture","code_information":[{"code":"26045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1269.35,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1269.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1294.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Incise finger tendon sheath","code_information":[{"code":"26055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":780.81,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":780.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":796.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Incision of finger tendon","code_information":[{"code":"26060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":685.49,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":685.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":698.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Explore/treat hand joint","code_information":[{"code":"26070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":869.47,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":869.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":886.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Explore/treat finger joint","code_information":[{"code":"26075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":909.92,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":909.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":927.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Repr elbw med ligmnt w/tissu","code_information":[{"code":"24345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1905.2,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1905.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1942.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Reconstruct elbow med ligmnt","code_information":[{"code":"24346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2951.93,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2951.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3009.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair elbow perc","code_information":[{"code":"24357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1112.9,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1112.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1134.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair elbow w/deb open","code_information":[{"code":"24358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1422.14,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1422.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1450.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair elbow deb/attch open","code_information":[{"code":"24359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1780.6,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1780.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1815.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2415.79,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2415.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2463.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2692.31,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2692.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2745.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2834.65,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2834.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2890.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Replace elbow joint","code_information":[{"code":"24363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3864.6,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3864.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3940.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Reconstruct head of radius","code_information":[{"code":"24365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1720.35,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1720.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1754.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct head of radius","code_information":[{"code":"24366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1822.73,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1822.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1858.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Revise reconst elbow joint","code_information":[{"code":"24370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4095.08,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4095.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4175.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Revise reconst elbow joint","code_information":[{"code":"24371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4710.5,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4710.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4803.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Revision of humerus","code_information":[{"code":"24400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2213.67,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2213.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2257.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of humerus","code_information":[{"code":"24410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2827.39,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2827.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2882.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of humerus","code_information":[{"code":"24420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2829.45,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2829.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2885.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair of humerus","code_information":[{"code":"24430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2819.49,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2819.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2874.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair humerus with graft","code_information":[{"code":"24435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2886.37,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2886.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2943.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of elbow joint","code_information":[{"code":"24470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1803.59,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1803.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1839.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Decompression of forearm","code_information":[{"code":"24495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2413.57,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2413.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2460.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Reinforce humerus","code_information":[{"code":"24498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2320.51,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2320.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2366.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":909.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":927.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1226.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1250.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2354.28,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2354.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2400.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2297.63,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2297.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2342.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":954.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":973.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1548.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1579.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2107.77,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2107.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2149.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2483.42,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2483.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2532.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2770.82,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2770.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2825.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":801.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":817.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1339.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1366.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1930.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1968.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.67,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2002.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":853.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":869.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1373.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1400.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2234.24,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2234.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2278.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2184.96,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2184.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2227.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2901.66,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2901.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2958.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2908.81,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2908.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2965.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":934.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":953.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1288.13,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1288.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1313.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1912.46,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1912.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1950.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1584.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1615.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1809.86,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1809.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1845.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.02,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":213.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":217.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":669.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":682.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1104.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1125.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1760.96,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1760.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1795.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1961.05,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1961.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1999.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":728.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":742.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1132.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1154.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1752.22,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1752.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1786.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fusion of elbow joint","code_information":[{"code":"24800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2232.4,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2232.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2276.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Fusion/graft of elbow joint","code_information":[{"code":"24802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2678.83,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2678.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2731.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation of upper arm","code_information":[{"code":"24900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1980.69,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1980.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2019.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation of upper arm","code_information":[{"code":"24920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1964.71,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1964.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2003.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"24925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1529.06,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1529.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1559.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"24930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2072.04,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2072.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2112.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputate upper arm & implant","code_information":[{"code":"24931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2488.81,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2488.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2537.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of amputation","code_information":[{"code":"24935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3251.71,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3251.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3315.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of upper arm","code_information":[{"code":"24940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2914.59,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2914.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2971.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incision of tendon sheath","code_information":[{"code":"25000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":927.16,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":927.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":945.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incise flexor carpi radialis","code_information":[{"code":"25001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":933.74,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":933.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":952.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Decompress forearm 1 space","code_information":[{"code":"25020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1931.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1969.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Decompress forearm 1 space","code_information":[{"code":"25023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3164.16,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3443.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3510.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Release knuckle contracture","code_information":[{"code":"26520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1784.92,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1784.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Release finger contracture","code_information":[{"code":"26525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1795.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1830.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Revise knuckle joint","code_information":[{"code":"26530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1455.63,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1455.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1484.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise knuckle with implant","code_information":[{"code":"26531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1692.82,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1692.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1726.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise finger joint","code_information":[{"code":"26535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1177.5,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1177.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1200.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise/implant finger joint","code_information":[{"code":"26536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1967.71,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1967.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2006.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair hand joint","code_information":[{"code":"26540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1842.34,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1842.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1878.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Repair hand joint with graft","code_information":[{"code":"26541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2207.78,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2207.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2251.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair hand joint with graft","code_information":[{"code":"26542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.19,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1903.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1940.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Reconstruct finger joint","code_information":[{"code":"26545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1937.46,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1937.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1975.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair nonunion hand","code_information":[{"code":"26546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2739.69,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2739.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2793.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Reconstruct finger joint","code_information":[{"code":"26548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2111.7,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2111.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2153.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Construct thumb replacement","code_information":[{"code":"26550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3164.16,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4380.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4466.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Great toe-hand transfer","code_information":[{"code":"26551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7017.06,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8748.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8920.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Single transfer toe-hand","code_information":[{"code":"26553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7017.06,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8690.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8861.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Double transfer toe-hand","code_information":[{"code":"26554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7017.06,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10122.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10321.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Positional change of finger","code_information":[{"code":"26555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3672.76,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3672.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3744.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Toe joint transfer","code_information":[{"code":"26556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7017.06,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9038.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9215.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair of web finger","code_information":[{"code":"26560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1674.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1706.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Repair of web finger","code_information":[{"code":"26561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2601.86,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2601.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2652.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair of web finger","code_information":[{"code":"26562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3164.16,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3651.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3722.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Correct metacarpal flaw","code_information":[{"code":"26565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1873.8,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1873.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1910.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Correct finger deformity","code_information":[{"code":"26567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1896.35,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1896.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1933.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Lengthen metacarpal/finger","code_information":[{"code":"26568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2450.11,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2450.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2498.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair hand deformity","code_information":[{"code":"26580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3164.16,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4091.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4172.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Reconstruct extra finger","code_information":[{"code":"26587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2789.99,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2789.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2844.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Repair finger deformity","code_information":[{"code":"26590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3802.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3877.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Repair muscles of hand","code_information":[{"code":"26591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1277.87,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1277.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1302.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Release muscles of hand","code_information":[{"code":"26593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1693.45,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1693.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1726.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Excision constricting tissue","code_information":[{"code":"26596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2169.45,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2169.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2212.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":778.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":794.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":807.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":823.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1356.77,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1356.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1383.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1294.95,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1294.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1320.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1542.92,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1542.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1573.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat thumb dislocation","code_information":[{"code":"26641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1037.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1057.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1072.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1093.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1291.92,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1291.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1317.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1677.69,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1677.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1710.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":857.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":873.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1145.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1168.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Pin hand dislocation","code_information":[{"code":"26676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1369.28,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1369.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1396.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1543.11,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1543.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1573.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1671.48,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1671.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1704.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":856.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":873.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1075.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1096.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Pin knuckle dislocation","code_information":[{"code":"26706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1202.69,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1202.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1226.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1537.58,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1537.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1567.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":516.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":526.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":830.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1275.92,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1275.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1300.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.85,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1595.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1627.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":599.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":611.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":911.85,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":911.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":929.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1984.26,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1984.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2023.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":518.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":529.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":748.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":762.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Pin finger fracture each","code_information":[{"code":"26756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1139.6,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1139.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1161.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1351.3,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1351.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1377.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat finger dislocation","code_information":[{"code":"26770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":720.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":734.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat finger dislocation","code_information":[{"code":"26775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.47,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":964.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":983.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Pin finger dislocation","code_information":[{"code":"26776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1208.05,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1208.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1231.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat finger dislocation","code_information":[{"code":"26785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1468.03,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1496.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Thumb fusion with graft","code_information":[{"code":"26820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2192.19,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2192.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2235.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Fusion of thumb","code_information":[{"code":"26841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2043.22,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2043.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2083.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Thumb fusion with graft","code_information":[{"code":"26842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2198.46,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2198.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2241.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Fusion of hand joint","code_information":[{"code":"26843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2066.02,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2066.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2106.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Fusion/graft of hand joint","code_information":[{"code":"26844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2274.44,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2274.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2319.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Fusion of knuckle","code_information":[{"code":"26850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1936.14,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1936.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1974.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Fusion of knuckle with graft","code_information":[{"code":"26852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2203.3,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2203.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2246.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Fusion of finger joint","code_information":[{"code":"26860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1607.1,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1607.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1638.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Fusion of finger jnt add-on","code_information":[{"code":"26861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.55,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":270.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":275.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Fusion/graft of finger joint","code_information":[{"code":"26862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2023.12,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2023.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2062.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Fuse/graft added joint","code_information":[{"code":"26863","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":603.71,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":603.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":615.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Amputate metacarpal bone","code_information":[{"code":"26910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2010.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2010.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2050.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Amputation of finger/thumb","code_information":[{"code":"26951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1847.23,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1847.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1883.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Amputation of finger/thumb","code_information":[{"code":"26952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1801.11,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1801.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1836.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Drainage of pelvis lesion","code_information":[{"code":"26990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1808.21,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1808.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1843.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Drainage of pelvis bursa","code_information":[{"code":"26991","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1413.58,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1413.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1441.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"26992","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2691.76,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2691.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2744.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1043.24,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1043.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1063.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1448.07,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1448.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1476.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1608.56,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1608.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1640.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1929.02,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1929.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1966.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incision of hip tendons","code_information":[{"code":"27006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1908.69,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1908.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Incision of hip/thigh fascia","code_information":[{"code":"27025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2479.4,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2479.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2528.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Buttock fasciotomy","code_information":[{"code":"27027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2369.79,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2369.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2416.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Drainage of hip joint","code_information":[{"code":"27030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2502.39,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2502.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2551.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Exploration of hip joint","code_information":[{"code":"27033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2595.45,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2595.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2646.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Denervation of hip joint","code_information":[{"code":"27035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2978.11,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2978.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3036.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Excision of hip joint/muscle","code_information":[{"code":"27036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2720.19,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2720.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2773.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Biopsy of soft tissues","code_information":[{"code":"27040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":528.47,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":528.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":538.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Biopsy of soft tissues","code_information":[{"code":"27041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1597.16,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1895.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1932.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Exc hip pelvis les sc 3 cm/>","code_information":[{"code":"27043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1261.18,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1261.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc hip/pelv tum deep 5 cm/>","code_information":[{"code":"27045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1965.26,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1965.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2003.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc hip/pelvis les sc < 3 cm","code_information":[{"code":"27047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":970.92,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":970.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":989.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc hip/pelv tum deep < 5 cm","code_information":[{"code":"27048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.04,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1643.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1675.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect hip/pelv tum < 5 cm","code_information":[{"code":"27049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2808.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3801.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3875.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Biopsy of sacroiliac joint","code_information":[{"code":"27050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1090.32,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1090.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1111.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Biopsy of hip joint","code_information":[{"code":"27052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.44,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1554.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1584.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of hip joint lining","code_information":[{"code":"27054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1843.96,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1843.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1880.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Buttock fasciotomy w/dbrdmt","code_information":[{"code":"27057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2692.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2745.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Resect hip/pelv tum 5 cm/>","code_information":[{"code":"27059","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2808.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4843.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4938.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of ischial bursa","code_information":[{"code":"27060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1253.15,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1253.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1277.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove femur lesion/bursa","code_information":[{"code":"27062","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1218.97,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1218.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1242.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove hip bone les super","code_information":[{"code":"27065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1401.46,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1401.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1428.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove hip bone les deep","code_information":[{"code":"27066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2181.3,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2181.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2224.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove/graft hip bone lesion","code_information":[{"code":"27067","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2767.33,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2767.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2821.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Part remove hip bone super","code_information":[{"code":"27070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2351.97,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2351.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2398.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Part removal hip bone deep","code_information":[{"code":"27071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2582.97,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2582.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2633.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Resect hip tumor","code_information":[{"code":"27075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5544.08,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5544.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5652.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Resect hip tum incl acetabul","code_information":[{"code":"27076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6699.94,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6699.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6831.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Resect hip tum w/innom bone","code_information":[{"code":"27077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7017.06,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7473.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7619.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Rsect hip tum incl femur","code_information":[{"code":"27078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5467.17,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5467.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5574.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Removal of tail bone","code_information":[{"code":"27080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1365.71,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1365.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1392.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove hip foreign body","code_information":[{"code":"27086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":449.6,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":449.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":458.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove hip foreign body","code_information":[{"code":"27087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1652.5,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1652.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1684.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of hip prosthesis","code_information":[{"code":"27090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2217.38,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2217.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2260.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of hip prosthesis","code_information":[{"code":"27091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4243.88,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4243.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4327.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Injection for hip x-ray","code_information":[{"code":"27093","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":179.88,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Injection for hip x-ray","code_information":[{"code":"27095","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.33,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":217.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":221.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Explore/treat finger joint","code_information":[{"code":"26080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1070.82,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1070.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1091.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Biopsy hand joint lining","code_information":[{"code":"26100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":914.38,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":932.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Biopsy finger joint lining","code_information":[{"code":"26105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":919.71,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":919.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":937.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Biopsy finger joint lining","code_information":[{"code":"26110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":874.83,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":874.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":892.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc hand les sc 1.5 cm/>","code_information":[{"code":"26111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1115.81,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1115.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1137.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc hand tum deep 1.5 cm/>","code_information":[{"code":"26113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1466.55,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1466.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1495.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc hand les sc < 1.5 cm","code_information":[{"code":"26115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":891.25,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":891.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":908.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc hand tum deep < 1.5 cm","code_information":[{"code":"26116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1407.45,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1407.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1435.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Rad resect hand tumor < 3 cm","code_information":[{"code":"26117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1989.63,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1989.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2028.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Rad resect hand tumor 3 cm/>","code_information":[{"code":"26118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2798.02,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2798.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2852.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Release palm contracture","code_information":[{"code":"26121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1608.12,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1608.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1639.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Release palm contracture","code_information":[{"code":"26123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2241.42,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2241.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2285.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Release palm contracture","code_information":[{"code":"26125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":714.34,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":714.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":728.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Remove wrist joint lining","code_information":[{"code":"26130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1261.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1261.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Revise finger joint each","code_information":[{"code":"26135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1485.74,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1485.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1514.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revise finger joint each","code_information":[{"code":"26140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1365.05,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1365.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1391.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Tendon excision palm/finger","code_information":[{"code":"26145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1385.89,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1385.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1413.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove tendon sheath lesion","code_information":[{"code":"26160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":848.93,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":848.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":865.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Removal of palm tendon each","code_information":[{"code":"26170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1097.69,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1097.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1119.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Removal of finger tendon","code_information":[{"code":"26180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1209.04,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1209.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1232.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove finger bone","code_information":[{"code":"26185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1496.61,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1496.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1525.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove hand bone lesion","code_information":[{"code":"26200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1212.26,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1212.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1236.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"26205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1624.76,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1624.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1656.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of finger lesion","code_information":[{"code":"26210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1203.79,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1203.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1227.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove/graft finger lesion","code_information":[{"code":"26215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1524.63,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1524.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1554.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Partial removal of hand bone","code_information":[{"code":"26230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1343.21,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1343.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1369.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Partial removal finger bone","code_information":[{"code":"26235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1325.06,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1325.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1351.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Partial removal finger bone","code_information":[{"code":"26236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.97,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1187.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1211.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Extensive hand surgery","code_information":[{"code":"26250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2846.88,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2846.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2902.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect prox finger tumor","code_information":[{"code":"26260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2132.96,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2132.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2174.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect distal finger tumor","code_information":[{"code":"26262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1691.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1725.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Removal of implant from hand","code_information":[{"code":"26320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":937.53,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":937.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":955.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Manipulate finger w/anesth","code_information":[{"code":"26340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":950.13,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":950.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":968.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Manipulat palm cord post inj","code_information":[{"code":"26341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.79,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":207.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":211.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1958.69,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1958.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1997.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2187.27,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2187.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2230.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2120.17,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2161.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2379.0,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2379.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2425.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2626.0,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2626.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2677.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2058.54,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2058.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2098.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2409.91,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2409.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2457.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2316.85,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2316.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2362.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revise hand/finger tendon","code_information":[{"code":"26390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2320.2,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2320.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2365.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2641.6,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2641.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2693.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair hand tendon","code_information":[{"code":"26410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1576.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1607.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1881.28,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1881.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1918.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Excision hand/finger tendon","code_information":[{"code":"26415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2242.93,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2242.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2286.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Graft hand or finger tendon","code_information":[{"code":"26416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2430.84,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2430.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2478.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1633.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1665.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1954.32,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1954.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1992.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1353.44,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1353.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1380.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2097.18,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2097.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2138.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1424.45,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1424.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1452.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1500.13,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1500.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1529.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1831.69,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1831.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1867.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Realignment of tendons","code_information":[{"code":"26437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1754.42,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1754.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1788.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Release palm/finger tendon","code_information":[{"code":"26440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1702.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1735.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Release palm & finger tendon","code_information":[{"code":"26442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2607.52,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2607.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2658.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Release hand/finger tendon","code_information":[{"code":"26445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.31,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1578.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1609.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Release forearm/hand tendon","code_information":[{"code":"26449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1872.7,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1872.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1909.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Incision of palm tendon","code_information":[{"code":"26450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1220.62,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1220.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Incision of finger tendon","code_information":[{"code":"26455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1212.86,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1212.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1236.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Incise hand/finger tendon","code_information":[{"code":"26460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1186.65,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1186.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1209.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Fusion of finger tendons","code_information":[{"code":"26471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1736.9,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1736.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1771.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Fusion of finger tendons","code_information":[{"code":"26474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1714.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1748.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Tendon lengthening","code_information":[{"code":"26476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1693.12,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1693.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1726.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Tendon shortening","code_information":[{"code":"26477","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1653.27,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1653.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1685.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Lengthening of hand tendon","code_information":[{"code":"26478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1731.62,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1731.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1765.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Shortening of hand tendon","code_information":[{"code":"26479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1778.95,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1778.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1813.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Transplant hand tendon","code_information":[{"code":"26480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2061.24,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2061.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2101.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Transplant/graft hand tendon","code_information":[{"code":"26483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2293.67,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2293.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2338.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Transplant palm tendon","code_information":[{"code":"26485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2199.23,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2199.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2242.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Transplant/graft palm tendon","code_information":[{"code":"26489","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2542.38,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2542.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2592.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revise thumb tendon","code_information":[{"code":"26490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2215.43,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2215.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2258.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Tendon transfer with graft","code_information":[{"code":"26492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2452.86,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2452.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2501.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Hand tendon/muscle transfer","code_information":[{"code":"26494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2225.3,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2225.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2269.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revise thumb tendon","code_information":[{"code":"26496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2398.91,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2398.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2446.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Finger tendon transfer","code_information":[{"code":"26497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2395.28,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2395.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2442.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Finger tendon transfer","code_information":[{"code":"26498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3125.54,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3125.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3186.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revision of finger","code_information":[{"code":"26499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2303.13,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2303.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2348.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Hand tendon reconstruction","code_information":[{"code":"26500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1811.1,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1811.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1846.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Hand tendon reconstruction","code_information":[{"code":"26502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1994.58,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1994.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2033.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Release thumb contracture","code_information":[{"code":"26508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1782.77,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1782.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1817.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Thumb tendon transfer","code_information":[{"code":"26510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1684.71,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1684.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1717.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Fusion of knuckle joint","code_information":[{"code":"26516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1960.7,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1960.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1999.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Fusion of knuckle joints","code_information":[{"code":"26517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2289.68,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2289.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2334.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Fusion of knuckle joints","code_information":[{"code":"26518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2319.19,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2319.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2364.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of knee cartilage","code_information":[{"code":"27332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1731.92,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1731.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1765.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of knee cartilage","code_information":[{"code":"27333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1582.52,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1582.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1613.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove knee joint lining","code_information":[{"code":"27334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1839.5,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1839.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1875.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove knee joint lining","code_information":[{"code":"27335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2053.26,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2053.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2093.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Exc thigh/knee les sc 3 cm/>","code_information":[{"code":"27337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1125.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1125.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1148.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc thigh/knee tum dep 5cm/>","code_information":[{"code":"27339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2025.93,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2025.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2065.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of kneecap bursa","code_information":[{"code":"27340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1008.21,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1008.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1028.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of knee cyst","code_information":[{"code":"27345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1305.81,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1305.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1331.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove knee cyst","code_information":[{"code":"27347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1415.76,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1415.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1443.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of kneecap","code_information":[{"code":"27350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1754.53,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1754.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1788.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove femur lesion","code_information":[{"code":"27355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1630.45,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1630.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1662.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove femur lesion/graft","code_information":[{"code":"27356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1984.29,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1984.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2023.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove femur lesion/graft","code_information":[{"code":"27357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2189.66,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2189.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2232.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove femur lesion/fixation","code_information":[{"code":"27358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":729.14,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":729.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":743.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Partial removal leg bone(s)","code_information":[{"code":"27360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2402.7,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2402.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2449.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Resect thigh/knee tum 5 cm/>","code_information":[{"code":"27364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2808.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4177.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4259.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Resect femur/knee tumor","code_information":[{"code":"27365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3164.16,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5465.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5573.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Njx cntrst kne arthg/ct/mri","code_information":[{"code":"27369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.51,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Removal of foreign body","code_information":[{"code":"27372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1071.4,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1071.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1092.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair of kneecap tendon","code_information":[{"code":"27380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1661.19,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1661.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1693.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair/graft kneecap tendon","code_information":[{"code":"27381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2189.22,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2189.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2232.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair of thigh muscle","code_information":[{"code":"27385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1617.17,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1617.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1648.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair/graft of thigh muscle","code_information":[{"code":"27386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2283.82,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2283.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2328.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Incision of thigh tendon","code_information":[{"code":"27390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1212.17,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1212.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.16,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1554.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1584.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1913.78,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1913.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1951.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Lengthening of thigh tendon","code_information":[{"code":"27393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1346.4,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1346.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1372.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Lengthening of thigh tendons","code_information":[{"code":"27394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1757.91,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1757.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1792.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Lengthening of thigh tendons","code_information":[{"code":"27395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2361.26,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2361.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2407.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Transplant of thigh tendon","code_information":[{"code":"27396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1659.63,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1659.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1692.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Transplants of thigh tendons","code_information":[{"code":"27397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2449.07,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2449.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2497.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise thigh muscles/tendons","code_information":[{"code":"27400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1865.41,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1865.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1902.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair of knee cartilage","code_information":[{"code":"27403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1731.07,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1731.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1765.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair of knee ligament","code_information":[{"code":"27405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1813.05,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1813.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1848.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair of knee ligament","code_information":[{"code":"27407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2133.92,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2133.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2175.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair of knee ligaments","code_information":[{"code":"27409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2584.84,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2584.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2635.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Autochondrocyte implant knee","code_information":[{"code":"27412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4392.44,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4392.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4478.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Osteochondral knee allograft","code_information":[{"code":"27415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3661.57,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3661.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3733.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Osteochondral knee autograft","code_information":[{"code":"27416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2620.48,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2620.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2671.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair degenerated kneecap","code_information":[{"code":"27418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2197.86,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2197.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2241.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of unstable kneecap","code_information":[{"code":"27420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2010.31,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2010.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2049.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of unstable kneecap","code_information":[{"code":"27422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1987.54,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1987.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2026.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision/removal of kneecap","code_information":[{"code":"27424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2006.7,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2006.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2046.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Lat retinacular release open","code_information":[{"code":"27425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1220.48,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1220.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1898.22,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1898.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1935.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2984.82,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2984.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3043.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3363.97,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3363.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3430.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of thigh muscles","code_information":[{"code":"27430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1989.87,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1989.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2028.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Incision of knee joint","code_information":[{"code":"27435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2159.8,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2159.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2202.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revise kneecap","code_information":[{"code":"27437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1774.3,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1774.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1809.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise kneecap with implant","code_information":[{"code":"27438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2250.33,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2250.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2294.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2136.45,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2136.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2178.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2205.34,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2205.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2248.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2323.61,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2323.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2369.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2186.53,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2186.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2229.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3063.34,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3063.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3123.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14383.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Total knee arthroplasty","code_information":[{"code":"27447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3420.95,"maximum":19178.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3420.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3488.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19178.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Incision of thigh","code_information":[{"code":"27448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2216.03,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2216.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2259.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incision of thigh","code_information":[{"code":"27450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2695.85,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2695.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2748.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Realignment of thigh bone","code_information":[{"code":"27454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3451.91,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3451.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3519.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Realignment of knee","code_information":[{"code":"27455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2564.65,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2564.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2615.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Realignment of knee","code_information":[{"code":"27457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2524.45,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2524.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2574.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Osteot femur imed lngth dev","code_information":[{"code":"27458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4605.1,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4605.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4695.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Shortening of thigh bone","code_information":[{"code":"27465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3329.18,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3329.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3394.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Lengthening of thigh bone","code_information":[{"code":"27466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3162.8,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3162.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3224.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair of thigh","code_information":[{"code":"27470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3152.88,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3152.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3214.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair/graft of thigh","code_information":[{"code":"27472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3375.3,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3375.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3441.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1779.42,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1779.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1814.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27477","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1966.47,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1966.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2005.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2456.66,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2456.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2504.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1801.5,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1801.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1836.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revise/replace knee joint","code_information":[{"code":"27486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.97,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3742.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3816.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Revise/replace knee joint","code_information":[{"code":"27487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4670.52,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4670.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4762.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Removal of knee prosthesis","code_information":[{"code":"27488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3203.39,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3203.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3266.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Reinforce thigh","code_information":[{"code":"27495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3016.45,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3016.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3075.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1473.56,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1473.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1502.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1559.17,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1559.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1762.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1797.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1882.4,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1882.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1919.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1294.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1320.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1338.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1365.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2024.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2063.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2141.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2183.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3569.09,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3569.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3639.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2582.66,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2582.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2633.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1342.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1369.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1800.04,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1800.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1835.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1833.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1869.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2658.7,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2658.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2710.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3293.9,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3293.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3358.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2577.19,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2577.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2627.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1310.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1336.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1851.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1887.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2377.54,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2377.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2424.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat kneecap fracture","code_information":[{"code":"27520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":817.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":833.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat kneecap fracture","code_information":[{"code":"27524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2016.93,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2016.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2056.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":782.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":798.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.56,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1561.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1592.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2394.81,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2394.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2441.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3170.37,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3170.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3232.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat knee fracture(s)","code_information":[{"code":"27538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1214.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1238.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2176.74,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2176.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2219.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1272.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1297.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1703.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1737.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2340.06,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2340.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2386.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2787.35,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2787.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2842.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3170.15,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3170.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3232.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat kneecap dislocation","code_information":[{"code":"27560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":928.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":947.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat kneecap dislocation","code_information":[{"code":"27562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1321.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1347.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat kneecap dislocation","code_information":[{"code":"27566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2389.56,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2389.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2436.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fixation of knee joint","code_information":[{"code":"27570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":410.66,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":410.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":418.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Fusion of knee","code_information":[{"code":"27580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.62,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3931.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4008.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2101.0,"maximum":14485.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2101.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2142.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2575.6,"maximum":14485.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2575.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2626.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1792.42,"maximum":14485.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1792.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1827.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1347.53,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1347.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1373.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1900.36,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1900.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1937.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputate lower leg at knee","code_information":[{"code":"27598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1854.77,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1854.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1891.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.71,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1068.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1089.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1180.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1180.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1204.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1275.34,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1275.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1300.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Inject sacroiliac joint","code_information":[{"code":"27096","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":219.62,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":219.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":223.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Revision of hip tendon","code_information":[{"code":"27097","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1831.34,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1831.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1867.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Transfer tendon to pelvis","code_information":[{"code":"27098","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1863.54,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1863.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1900.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Transfer of abdominal muscle","code_information":[{"code":"27100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2221.67,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2221.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2265.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Transfer of spinal muscle","code_information":[{"code":"27105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2329.06,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2329.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2374.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Transfer of iliopsoas muscle","code_information":[{"code":"27110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2594.74,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2594.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2645.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Transfer of iliopsoas muscle","code_information":[{"code":"27111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2415.85,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2415.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2463.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruction of hip socket","code_information":[{"code":"27120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3464.37,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3464.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3532.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Reconstruction of hip socket","code_information":[{"code":"27122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2945.99,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2945.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3003.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Partial hip replacement","code_information":[{"code":"27125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3019.86,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3019.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3079.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Total hip arthroplasty","code_information":[{"code":"27130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3426.17,"maximum":19178.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3426.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3493.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19178.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Total hip arthroplasty","code_information":[{"code":"27132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4451.29,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4451.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4538.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5073.15,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5073.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5172.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3905.58,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3905.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3982.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4056.88,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4056.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4136.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Transplant femur ridge","code_information":[{"code":"27140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2398.58,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2398.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2445.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incision of hip bone","code_information":[{"code":"27146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3412.53,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3412.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3479.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of hip bone","code_information":[{"code":"27147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3900.05,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3900.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3976.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incision of hip bones","code_information":[{"code":"27151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4214.05,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4214.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4296.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of hip bones","code_information":[{"code":"27156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4540.64,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4540.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4629.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of pelvis","code_information":[{"code":"27158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3730.76,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3730.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3804.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incision of neck of femur","code_information":[{"code":"27161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3255.95,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3255.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3319.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incision/fixation of femur","code_information":[{"code":"27165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3657.25,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3657.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3729.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair/graft femur head/neck","code_information":[{"code":"27170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3122.3,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3122.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3183.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1786.7,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1786.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1821.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2465.1,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2465.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2513.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Drain lower leg lesion","code_information":[{"code":"27603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1038.92,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1038.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1059.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Drain lower leg bursa","code_information":[{"code":"27604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":862.59,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":862.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":879.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of achilles tendon","code_information":[{"code":"27605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":487.36,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":487.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":496.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of achilles tendon","code_information":[{"code":"27606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":719.92,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":719.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":734.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat lower leg bone lesion","code_information":[{"code":"27607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1601.85,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1633.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Explore/treat ankle joint","code_information":[{"code":"27610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1725.43,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1725.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1759.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Exploration of ankle joint","code_information":[{"code":"27612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1528.92,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1528.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1558.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Biopsy lower leg soft tissue","code_information":[{"code":"27613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":429.47,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":429.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":437.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Biopsy lower leg soft tissue","code_information":[{"code":"27614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1111.11,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1111.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1132.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Resect leg/ankle tum < 5 cm","code_information":[{"code":"27615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2712.66,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2712.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2765.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect leg/ankle tum 5 cm/>","code_information":[{"code":"27616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2808.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3367.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3433.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc leg/ankle tum < 3 cm","code_information":[{"code":"27618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":817.99,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":817.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":834.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc leg/ankle tum deep <5 cm","code_information":[{"code":"27619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1261.29,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1261.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Explore/treat ankle joint","code_information":[{"code":"27620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1198.09,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1198.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1221.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove ankle joint lining","code_information":[{"code":"27625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1532.52,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1532.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1562.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove ankle joint lining","code_information":[{"code":"27626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1657.4,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1657.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1689.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of tendon lesion","code_information":[{"code":"27630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":955.49,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":955.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":974.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc leg/ankle les sc 3 cm/>","code_information":[{"code":"27632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1095.13,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1095.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1116.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc leg/ankle tum dep 5 cm/>","code_information":[{"code":"27634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1800.87,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1800.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1836.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove lower leg bone lesion","code_information":[{"code":"27635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1549.85,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1549.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1580.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove/graft leg bone lesion","code_information":[{"code":"27637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1997.13,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1997.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2036.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2979.46,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2979.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3037.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2465.1,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2465.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2513.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revise head/neck of femur","code_information":[{"code":"27179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2614.32,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2614.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2665.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2992.11,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2992.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3050.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of femur epiphysis","code_information":[{"code":"27185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1926.13,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1926.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Reinforce hip bones","code_information":[{"code":"27187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2660.96,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2660.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2713.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Clsd tx pelvic ring fx","code_information":[{"code":"27197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":352.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":359.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Clsd tx pelvic ring fx","code_information":[{"code":"27198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":840.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":857.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat tail bone fracture","code_information":[{"code":"27200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":518.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":528.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat tail bone fracture","code_information":[{"code":"27202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1416.66,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1416.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1444.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat pelvic fracture(s)","code_information":[{"code":"27215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1612.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1644.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat pelvic ring fracture","code_information":[{"code":"27216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2384.42,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2384.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2431.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Treat pelvic ring fracture","code_information":[{"code":"27217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2241.06,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2241.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2285.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat pelvic ring fracture","code_information":[{"code":"27218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3079.12,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3079.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3139.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat hip socket fracture","code_information":[{"code":"27220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1110.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1132.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat hip socket fracture","code_information":[{"code":"27222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2618.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2670.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat hip wall fracture","code_information":[{"code":"27226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2826.29,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2826.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2881.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat hip fracture(s)","code_information":[{"code":"27227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4399.97,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4399.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4486.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat hip fracture(s)","code_information":[{"code":"27228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5002.53,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5002.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5100.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1289.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1314.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1953.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1991.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2422.89,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2422.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2470.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3185.0,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3185.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3247.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1260.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1284.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2547.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2597.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3275.22,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3275.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3339.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3270.82,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3270.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3335.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1044.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1064.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1992.21,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1992.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2031.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":487.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":497.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2008.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2047.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2510.17,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2510.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2559.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3392.79,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3392.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3459.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":651.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":664.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":967.12,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":967.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":986.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2968.76,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2968.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3027.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3164.16,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4113.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4194.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1130.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1153.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1564.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1595.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Cltx thigh fx","code_information":[{"code":"27267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1191.58,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1191.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1214.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Cltx thigh fx w/mnpj","code_information":[{"code":"27268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1463.88,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1463.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1492.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Optx thigh fx","code_information":[{"code":"27269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3307.92,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3307.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3372.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Manipulation of hip joint","code_information":[{"code":"27275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":491.65,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":491.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":501.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Arthrd si jt prq wo tfxj dev","code_information":[{"code":"27278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1242.97,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1242.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1267.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Arthrodesis sacroiliac joint","code_information":[{"code":"27279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2140.74,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2140.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2182.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Fusion of sacroiliac joint","code_information":[{"code":"27280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3660.53,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3660.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3732.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Fusion of pubic bones","code_information":[{"code":"27282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2299.52,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2299.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2344.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fusion of hip joint","code_information":[{"code":"27284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4274.19,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4274.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4358.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Fusion of hip joint","code_information":[{"code":"27286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4376.93,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4376.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4462.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Amputation of leg at hip","code_information":[{"code":"27290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4327.9,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4327.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4412.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Amputation of leg at hip","code_information":[{"code":"27295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3370.13,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3370.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3436.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Drain thigh/knee lesion","code_information":[{"code":"27301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1363.2,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1363.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1389.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"27303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1718.75,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1718.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1752.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Incise thigh tendon & fascia","code_information":[{"code":"27305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1296.76,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1296.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1322.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of thigh tendon","code_information":[{"code":"27306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":918.06,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":918.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":936.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1093.1,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1093.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1114.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Exploration of knee joint","code_information":[{"code":"27310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.09,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2001.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Biopsy thigh soft tissues","code_information":[{"code":"27323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":464.04,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":464.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":473.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Biopsy thigh soft tissues","code_information":[{"code":"27324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1100.61,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1100.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1122.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Neurectomy hamstring","code_information":[{"code":"27325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1515.5,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1515.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1545.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1888.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2738.13,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2454.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Neurectomy popliteal","code_information":[{"code":"27326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1402.69,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1402.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1430.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1888.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2738.13,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2454.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc thigh/knee les sc < 3 cm","code_information":[{"code":"27327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":844.22,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":844.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":860.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc thigh/knee tum deep <5cm","code_information":[{"code":"27328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1673.68,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1673.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1706.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect thigh/knee tum < 5 cm","code_information":[{"code":"27329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2785.06,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2785.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2839.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Biopsy knee joint lining","code_information":[{"code":"27330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1137.7,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1137.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1160.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Explore/treat knee joint","code_information":[{"code":"27331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1281.17,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1281.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1306.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1725.57,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1725.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1759.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":829.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":845.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1162.26,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1162.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1185.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2043.2,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2043.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2083.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":799.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":815.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1196.09,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1196.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1219.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2323.48,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2323.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2369.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2621.55,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2621.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2673.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":826.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":843.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1331.0,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1331.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1357.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2271.01,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2271.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2315.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2979.1,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2979.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3037.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3530.48,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3530.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3599.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat lower leg joint","code_information":[{"code":"27829","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1881.3,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1881.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1918.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":976.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":995.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1104.4,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1104.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2031.04,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2031.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2070.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1050.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1071.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1326.55,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1326.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1352.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1947.3,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1947.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1985.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2111.51,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2111.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2152.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fixation of ankle joint","code_information":[{"code":"27860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.96,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":435.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":444.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Fusion of ankle joint open","code_information":[{"code":"27870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2693.13,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2693.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2746.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fusion of tibiofibular joint","code_information":[{"code":"27871","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1847.75,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1847.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1884.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2404.38,"maximum":14485.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2404.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2451.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2246.83,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2246.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2290.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1581.47,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1581.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1612.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1544.37,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1544.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1574.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1731.32,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1731.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1765.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation of foot at ankle","code_information":[{"code":"27888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1540.99,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1540.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1571.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation of foot at ankle","code_information":[{"code":"27889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1713.88,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1713.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1747.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Decompression of leg","code_information":[{"code":"27892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1434.37,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1434.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1462.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Decompression of leg","code_information":[{"code":"27893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1646.21,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1646.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1678.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Decompression of leg","code_information":[{"code":"27894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2177.7,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2177.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2220.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Drainage of bursa of foot","code_information":[{"code":"28001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":256.69,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":256.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":261.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treatment of foot infection","code_information":[{"code":"28002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.94,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":374.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":382.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treatment of foot infection","code_information":[{"code":"28003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":692.34,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":692.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":705.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat foot bone lesion","code_information":[{"code":"28005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1523.94,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1523.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1553.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of foot fascia","code_information":[{"code":"28008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":785.02,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":785.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":800.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of toe tendon","code_information":[{"code":"28010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":554.04,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":554.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":564.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of toe tendons","code_information":[{"code":"28011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":745.58,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":745.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":760.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exploration of foot joint","code_information":[{"code":"28020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":973.45,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":973.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":992.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exploration of foot joint","code_information":[{"code":"28022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":873.32,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":873.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":890.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exploration of toe joint","code_information":[{"code":"28024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":821.7,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":821.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":837.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Decompression of tibia nerve","code_information":[{"code":"28035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":956.26,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":956.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":975.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1888.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2738.13,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2454.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc foot/toe tum sc 1.5 cm/>","code_information":[{"code":"28039","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":904.09,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":904.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":921.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc foot/toe tum dep 1.5cm/>","code_information":[{"code":"28041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1204.23,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1204.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1227.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exc foot/toe tum sc < 1.5 cm","code_information":[{"code":"28043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":696.27,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":696.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":709.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exc foot/toe tum deep <1.5cm","code_information":[{"code":"28045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":925.84,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":925.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":944.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect foot/toe tumor < 3 cm","code_information":[{"code":"28046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1870.08,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1870.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1906.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Resect foot/toe tumor 3 cm/>","code_information":[{"code":"28047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2767.3,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2767.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2821.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.98,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.25,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4073.02,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3651.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Biopsy of foot joint lining","code_information":[{"code":"28050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":744.34,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":744.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":758.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Biopsy of foot joint lining","code_information":[{"code":"28052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":682.96,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":682.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":696.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Biopsy of toe joint lining","code_information":[{"code":"28054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":623.37,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":623.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":635.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Neurectomy foot","code_information":[{"code":"28055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1040.16,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1040.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1060.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1888.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2738.13,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2454.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Partial removal foot fascia","code_information":[{"code":"28060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":961.13,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":961.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":980.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of foot fascia","code_information":[{"code":"28062","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1080.39,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1080.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1101.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of foot joint lining","code_information":[{"code":"28070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":914.35,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":932.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of foot joint lining","code_information":[{"code":"28072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":867.57,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":867.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":884.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1003.48,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1003.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1023.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Excise foot tendon sheath","code_information":[{"code":"28086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":932.88,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":932.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":951.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Excise foot tendon sheath","code_information":[{"code":"28088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":782.49,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":782.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":797.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":822.88,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":822.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":839.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of toe lesions","code_information":[{"code":"28092","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":725.64,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":725.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":739.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of ankle/heel lesion","code_information":[{"code":"28100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1113.26,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1113.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1135.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.01,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1638.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1670.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1035.02,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1035.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1055.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":946.25,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":946.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":964.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1137.98,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1137.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1160.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":924.0,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":924.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":942.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Removal of toe lesions","code_information":[{"code":"28108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":769.2,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":769.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":784.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":782.32,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":782.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":797.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.68,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":851.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":868.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":834.71,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":834.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":851.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1134.65,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1134.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1156.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of metatarsal heads","code_information":[{"code":"28114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2226.65,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2226.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2270.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Revision of foot","code_information":[{"code":"28116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1555.04,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1555.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1585.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of heel bone","code_information":[{"code":"28118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1128.22,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1128.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1150.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of heel spur","code_information":[{"code":"28119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":973.17,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":973.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":992.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Part removal of ankle/heel","code_information":[{"code":"28120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1322.01,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1322.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1347.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Partial removal of foot bone","code_information":[{"code":"28122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1172.35,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1172.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1195.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":891.39,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":891.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":908.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":668.86,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":668.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":681.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of ankle bone","code_information":[{"code":"28130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1650.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1650.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1683.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of metatarsal","code_information":[{"code":"28140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1139.33,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1139.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1161.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of toe","code_information":[{"code":"28150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":745.5,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":745.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":760.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.85,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":702.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":716.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":711.23,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":711.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":725.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Resect tarsal tumor","code_information":[{"code":"28171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2955.23,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2955.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3013.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Resect metatarsal tumor","code_information":[{"code":"28173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1941.91,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1941.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1980.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Resect phalanx of toe tumor","code_information":[{"code":"28175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1254.08,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1254.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1278.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":352.19,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":352.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":359.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.79,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":992.95,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":826.21,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":826.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":842.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":974.55,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":974.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":993.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1645.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2315.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2076.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Repair of foot tendon","code_information":[{"code":"28200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":871.09,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":871.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair/graft of foot tendon","code_information":[{"code":"28202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1144.41,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1144.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1166.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair of foot tendon","code_information":[{"code":"28208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":855.86,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":855.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":872.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair/graft of foot tendon","code_information":[{"code":"28210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1132.37,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1132.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1154.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Release of foot tendon","code_information":[{"code":"28220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":815.29,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":815.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":831.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Release of foot tendons","code_information":[{"code":"28222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":989.75,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":989.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1009.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Release of foot tendon","code_information":[{"code":"28225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":705.76,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":705.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":719.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Release of foot tendons","code_information":[{"code":"28226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1067.94,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1067.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1088.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of foot tendon(s)","code_information":[{"code":"28230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.91,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":759.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":774.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of toe tendon","code_information":[{"code":"28232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":642.62,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":642.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":655.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of foot tendon","code_information":[{"code":"28234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":716.68,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":716.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":730.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Revision of foot tendon","code_information":[{"code":"28238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1308.4,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1308.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1334.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Release of big toe","code_information":[{"code":"28240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":783.61,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":783.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":799.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Revision of foot fascia","code_information":[{"code":"28250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1101.07,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1101.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1122.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Release of midfoot joint","code_information":[{"code":"28260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1444.93,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1444.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1473.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Revision of foot tendon","code_information":[{"code":"28261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2253.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2297.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Revision of foot and ankle","code_information":[{"code":"28262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2958.23,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2958.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3016.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Release of midfoot joint","code_information":[{"code":"28264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1790.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1826.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Release of foot contracture","code_information":[{"code":"28270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":890.42,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":890.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":907.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Release of toe joint each","code_information":[{"code":"28272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":670.15,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":670.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":683.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Fusion of toes","code_information":[{"code":"28280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":920.21,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":920.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":938.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair of hammertoe","code_information":[{"code":"28285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1030.59,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1030.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1050.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair of hammertoe","code_information":[{"code":"28286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":794.97,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":794.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":810.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Partial removal of foot bone","code_information":[{"code":"28288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1158.05,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1158.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1180.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Corrj halux rigdus w/o implt","code_information":[{"code":"28289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1230.98,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1230.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1255.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Corrj halux rigdus w/implt","code_information":[{"code":"28291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.39,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1284.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1309.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1296.43,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1296.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1321.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1603.83,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1603.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1635.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1370.9,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1370.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1397.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1605.23,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1605.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1636.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1356.22,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1356.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1382.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1589.67,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1620.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Incision of heel bone","code_information":[{"code":"28300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1739.54,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1739.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1773.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incision of ankle bone","code_information":[{"code":"28302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1918.1,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1918.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1955.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of midfoot bones","code_information":[{"code":"28304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1641.53,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1641.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1673.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incise/graft midfoot bones","code_information":[{"code":"28305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1805.51,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1805.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1840.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1088.67,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1088.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1110.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1384.71,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1384.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1411.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1034.5,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1034.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of metatarsals","code_information":[{"code":"28309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2420.03,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2420.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2467.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of big toe","code_information":[{"code":"28310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":972.24,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":972.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":991.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Revision of toe","code_information":[{"code":"28312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":919.11,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":919.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":937.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair deformity of toe","code_information":[{"code":"28313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.44,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":984.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of sesamoid bone","code_information":[{"code":"28315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":869.52,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":869.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":886.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair of foot bones","code_information":[{"code":"28320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1650.11,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1650.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1682.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair of metatarsals","code_information":[{"code":"28322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1546.02,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1546.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1576.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Resect enlarged toe tissue","code_information":[{"code":"28340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1091.92,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1091.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1113.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Resect enlarged toe","code_information":[{"code":"28341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1299.62,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1299.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1325.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove/graft leg bone lesion","code_information":[{"code":"27638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1986.27,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1986.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2025.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Partial removal of tibia","code_information":[{"code":"27640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2222.69,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2222.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2266.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Partial removal of fibula","code_information":[{"code":"27641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1745.78,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1745.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1780.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Resect tibia tumor","code_information":[{"code":"27645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3164.16,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4706.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4799.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Resect fibula tumor","code_information":[{"code":"27646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3164.16,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4088.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4168.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Resect talus/calcaneus tum","code_information":[{"code":"27647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2666.4,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2666.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2718.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Injection for ankle x-ray","code_information":[{"code":"27648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":136.98,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Repair achilles tendon","code_information":[{"code":"27650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1753.87,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1753.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1788.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair/graft achilles tendon","code_information":[{"code":"27652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1797.9,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1797.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1833.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair of achilles tendon","code_information":[{"code":"27654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1912.13,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1912.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair leg fascia defect","code_information":[{"code":"27656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":911.02,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":911.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":928.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":987.22,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":987.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1006.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1265.28,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1265.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1290.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":967.48,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":967.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":986.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1132.86,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1132.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1155.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair lower leg tendons","code_information":[{"code":"27675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1326.57,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1326.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1352.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair lower leg tendons","code_information":[{"code":"27676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1630.2,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1630.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1662.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Release of lower leg tendon","code_information":[{"code":"27680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1125.16,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1125.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1147.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Release of lower leg tendons","code_information":[{"code":"27681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1357.98,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1357.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1384.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revision of lower leg tendon","code_information":[{"code":"27685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1246.58,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1246.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1271.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revise lower leg tendons","code_information":[{"code":"27686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1424.17,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1424.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1452.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revision of calf tendon","code_information":[{"code":"27687","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1214.51,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1214.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1238.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revise lower leg tendon","code_information":[{"code":"27690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1702.28,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1702.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1735.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise lower leg tendon","code_information":[{"code":"27691","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1983.03,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1983.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2021.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revise additional leg tendon","code_information":[{"code":"27692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":271.59,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":276.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Repair of ankle ligament","code_information":[{"code":"27695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1299.82,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1299.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1325.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair of ankle ligaments","code_information":[{"code":"27696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1467.46,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1467.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1496.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair of ankle ligament","code_information":[{"code":"27698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1705.28,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1705.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1738.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revision of ankle joint","code_information":[{"code":"27700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1906.52,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1906.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1943.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruct ankle joint","code_information":[{"code":"27702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2568.72,"maximum":38047.60,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2568.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2619.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26239.73,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27026.92,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":38047.6,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34111.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Reconstruction ankle joint","code_information":[{"code":"27703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2963.92,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2963.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3022.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Removal of ankle implant","code_information":[{"code":"27704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1514.87,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1514.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1544.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Incision of tibia","code_information":[{"code":"27705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.62,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2003.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2042.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Incision of fibula","code_information":[{"code":"27707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1082.84,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1082.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1104.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Incision of tibia & fibula","code_information":[{"code":"27709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3059.29,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3059.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3119.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Realignment of lower leg","code_information":[{"code":"27712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2944.59,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2944.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3002.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Osteot tibia imed lngth dev","code_information":[{"code":"27713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4672.69,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4672.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4764.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of lower leg","code_information":[{"code":"27715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2864.07,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2864.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2920.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair of tibia","code_information":[{"code":"27720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2330.76,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2376.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair/graft of tibia","code_information":[{"code":"27722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2393.44,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2393.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2440.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair/graft of tibia","code_information":[{"code":"27724","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3348.59,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3348.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3414.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair of lower leg","code_information":[{"code":"27725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.76,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3246.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3310.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair fibula nonunion","code_information":[{"code":"27726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2553.32,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2553.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2603.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair of lower leg","code_information":[{"code":"27727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2775.3,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2775.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2829.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair of tibia epiphysis","code_information":[{"code":"27730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1579.9,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1579.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1610.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair of fibula epiphysis","code_information":[{"code":"27732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1219.71,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1219.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1243.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair lower leg epiphyses","code_information":[{"code":"27734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.03,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1765.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1799.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair of leg epiphyses","code_information":[{"code":"27740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1899.32,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1899.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1936.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair of leg epiphyses","code_information":[{"code":"27742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2082.6,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2082.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2123.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reinforce tibia","code_information":[{"code":"27745","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1993.56,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1993.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2032.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":877.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":894.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27752","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1324.73,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1324.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1350.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1548.66,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1548.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1579.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27758","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2396.57,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2396.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2443.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2663.21,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2663.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2715.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Cltx medial ankle fx","code_information":[{"code":"27760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":834.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":851.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cltx med ankle fx w/mnpj","code_information":[{"code":"27762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1196.33,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1196.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1219.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Optx medial ankle fx","code_information":[{"code":"27766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1617.03,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1617.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1648.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Cltx post ankle fx","code_information":[{"code":"27767","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":782.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":797.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Cltx post ankle fx w/mnpj","code_information":[{"code":"27768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.0,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1211.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Optx post ankle fx","code_information":[{"code":"27769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1943.56,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1943.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1981.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":772.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":788.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1093.43,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1093.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1114.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3756.0}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1914.52,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1914.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1952.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":778.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":793.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1044.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1065.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Repair extra toe(s)","code_information":[{"code":"28344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":745.28,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":745.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":759.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair webbed toe(s)","code_information":[{"code":"28345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":967.31,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":967.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":986.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Reconstruct cleft foot","code_information":[{"code":"28360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2930.35,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2930.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2987.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treatment of heel fracture","code_information":[{"code":"28400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":619.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":631.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of heel fracture","code_information":[{"code":"28405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1096.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1118.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of heel fracture","code_information":[{"code":"28406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1575.45,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1575.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1606.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat heel fracture","code_information":[{"code":"28415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2986.36,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2986.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3045.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat/graft heel fracture","code_information":[{"code":"28420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3452.08,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3452.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3519.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":568.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":579.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":887.62,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":887.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":905.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1322.34,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1322.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1348.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat ankle fracture","code_information":[{"code":"28445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2802.25,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2802.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2857.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Osteochondral talus autogrft","code_information":[{"code":"28446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3269.06,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3269.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3333.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":514.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":525.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":614.6,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":614.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":626.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat midfoot fracture","code_information":[{"code":"28456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":980.46,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":980.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":999.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1710.72,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1710.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1744.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":551.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":562.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":619.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":631.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1023.69,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1023.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1043.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1500.92,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1500.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1530.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":334.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":340.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":401.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":408.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.81,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":728.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":743.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1325.97,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1325.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1352.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treatment of toe fracture","code_information":[{"code":"28510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":323.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":330.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treatment of toe fracture","code_information":[{"code":"28515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":385.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":393.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat toe fracture","code_information":[{"code":"28525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1086.75,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1086.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1108.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat sesamoid bone fracture","code_information":[{"code":"28530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":273.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":279.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat sesamoid bone fracture","code_information":[{"code":"28531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":483.51,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":483.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":493.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":472.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":481.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":730.95,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":730.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":745.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":942.95,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":942.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":961.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1771.3,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1771.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1806.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":533.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":543.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":915.45,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":915.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":933.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1045.47,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1045.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1066.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1891.31,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1891.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1928.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":431.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":439.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":822.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":838.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1052.12,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1052.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1072.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2203.47,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2203.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2246.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":298.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":304.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":349.39,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":349.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":356.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":595.9,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":595.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":607.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair toe dislocation","code_information":[{"code":"28645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1301.93,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1301.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1327.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.54,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":253.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":258.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.69,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":345.88,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.47,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":338.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":345.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.02,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":466.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":475.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair of toe dislocation","code_information":[{"code":"28675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1104.1,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1104.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1125.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3262.46,"maximum":24586.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3262.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3326.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16955.93,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17464.61,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":24586.1,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22042.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2502.56,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2502.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2551.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Application of long leg cast","code_information":[{"code":"29355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.47,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":282.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":288.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2571.31,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2571.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2621.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Surgery/speech prosthesis","code_information":[{"code":"31611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1438.97,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1438.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1467.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Puncture/clear windpipe","code_information":[{"code":"31612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.79,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair windpipe opening","code_information":[{"code":"31613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1136.69,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1136.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1159.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair windpipe opening","code_information":[{"code":"31614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1913.86,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1913.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1951.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Visualization of windpipe","code_information":[{"code":"31615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":312.46,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":312.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":318.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":521.55,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":537.2,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":756.25,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":678.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Dx bronchoscope/wash","code_information":[{"code":"31622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.29,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":356.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":363.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Dx bronchoscope/brush","code_information":[{"code":"31623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.65,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":353.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":360.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Dx bronchoscope/lavage","code_information":[{"code":"31624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":358.02,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":358.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":365.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Bronchoscopy w/biopsy(s)","code_information":[{"code":"31625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":418.85,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":418.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":427.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Bronchoscopy w/markers","code_information":[{"code":"31626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":529.38,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":529.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":539.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Navigational bronchoscopy","code_information":[{"code":"31627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":258.89,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":258.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":263.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Apply long leg cast brace","code_information":[{"code":"29358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.47,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":274.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":279.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of long leg cast","code_information":[{"code":"29365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":233.28,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":233.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Apply short leg cast","code_information":[{"code":"29405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.57,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":155.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":158.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Apply short leg cast","code_information":[{"code":"29425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.58,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":146.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Apply short leg cast","code_information":[{"code":"29435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.96,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":229.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":234.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Addition of walker to cast","code_information":[{"code":"29440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.24,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Apply rigid leg cast","code_information":[{"code":"29445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.74,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":262.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":267.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of leg cast","code_information":[{"code":"29450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.14,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":300.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":306.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application long leg splint","code_information":[{"code":"29505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.71,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application lower leg splint","code_information":[{"code":"29515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.28,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Strapping of hip","code_information":[{"code":"29520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.43,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.66,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.52,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":186.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":167.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Removal of larynx & pharynx","code_information":[{"code":"31390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7554.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7702.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Reconstruct larynx & pharynx","code_information":[{"code":"31395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7917.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8072.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Revision of larynx","code_information":[{"code":"31400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2709.16,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2709.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2762.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Removal of epiglottis","code_information":[{"code":"31420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2248.21,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2248.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2292.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Insert emergency airway","code_information":[{"code":"31500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.04,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":384.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":392.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.04,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":235.92,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":332.11,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":297.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Change of windpipe airway","code_information":[{"code":"31502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.9,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.04,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":235.92,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":332.11,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":297.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Diagnostic laryngoscopy","code_information":[{"code":"31505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.72,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.03,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.82,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":279.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":250.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Laryngoscopy with biopsy","code_information":[{"code":"31510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.8,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":327.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":334.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove foreign body larynx","code_information":[{"code":"31511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.03,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":364.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":371.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.03,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.82,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":279.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":250.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Removal of larynx lesion","code_information":[{"code":"31512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":350.65,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":350.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":357.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Injection into vocal cord","code_information":[{"code":"31513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.27,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":355.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":362.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.23,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":548.43,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":491.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Laryngoscopy for aspiration","code_information":[{"code":"31515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.11,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":300.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":306.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.23,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":548.43,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":491.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Dx laryngoscopy newborn","code_information":[{"code":"31520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":378.23,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":423.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":432.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.23,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":548.43,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":491.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Dx laryngoscopy excl nb","code_information":[{"code":"31525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":433.73,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":433.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":442.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Dx laryngoscopy w/oper scope","code_information":[{"code":"31526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.63,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":424.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":432.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Laryngoscopy for treatment","code_information":[{"code":"31527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":526.74,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":526.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":537.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Laryngoscopy and dilation","code_information":[{"code":"31528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.31,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":390.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":397.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Laryngoscopy and dilation","code_information":[{"code":"31529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.85,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":435.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":444.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Laryngoscopy w/fb removal","code_information":[{"code":"31530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.31,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":538.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":548.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Laryngoscopy w/fb & op scope","code_information":[{"code":"31531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.6,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":570.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":581.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Laryngoscopy w/biopsy","code_information":[{"code":"31535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":511.25,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":511.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":521.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Laryngoscopy w/bx & op scope","code_information":[{"code":"31536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.79,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":567.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":578.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Laryngoscopy w/exc of tumor","code_information":[{"code":"31540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":651.81,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":651.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":664.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Larynscop w/tumr exc + scope","code_information":[{"code":"31541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":711.12,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":711.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":725.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove vc lesion w/scope","code_information":[{"code":"31545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":978.09,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":978.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":997.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Remove vc lesion scope/graft","code_information":[{"code":"31546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.65,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1483.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1512.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.66,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":211.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":215.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.66,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.52,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":186.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":167.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.66,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":289.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":294.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.66,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.52,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":186.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":167.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Repeat control of nosebleed","code_information":[{"code":"30906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.04,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":361.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":368.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.04,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":235.92,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":332.11,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":297.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Ligation nasal sinus artery","code_information":[{"code":"30915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1627.59,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1627.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1659.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3053.41,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3145.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4427.45,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3969.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Ligation upper jaw artery","code_information":[{"code":"30920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2351.55,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2351.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2397.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3053.41,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3145.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4427.45,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3969.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Ther fx nasal inf turbinate","code_information":[{"code":"30930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.42,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":318.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":324.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Irrigation maxillary sinus","code_information":[{"code":"31000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.04,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":296.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":302.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.04,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":235.92,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":332.11,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":297.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Irrigation sphenoid sinus","code_information":[{"code":"31002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":504.38,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":504.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":514.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Exploration maxillary sinus","code_information":[{"code":"31020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":906.48,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":906.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":924.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exploration maxillary sinus","code_information":[{"code":"31030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1376.49,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1376.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1403.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Explore sinus remove polyps","code_information":[{"code":"31032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1593.65,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1593.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1624.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Exploration behind upper jaw","code_information":[{"code":"31040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2169.17,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2169.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2211.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exploration sphenoid sinus","code_information":[{"code":"31050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1383.88,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1383.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1411.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Sphenoid sinus surgery","code_information":[{"code":"31051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1857.02,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1857.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1893.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Exploration of frontal sinus","code_information":[{"code":"31070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1268.63,"maximum":8300.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1268.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1293.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Exploration of frontal sinus","code_information":[{"code":"31075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2222.14,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2222.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2265.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2925.45,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2925.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2982.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3139.92,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3139.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3201.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3252.1,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3252.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3315.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3352.44,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3352.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3418.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3164.51,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3164.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3226.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3022.11,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3022.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3081.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Exploration of sinuses","code_information":[{"code":"31090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2957.54,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2957.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3015.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1655.5,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1688.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1500.45,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2088.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2129.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2508.77,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2508.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2558.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of upper jaw","code_information":[{"code":"31225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4865.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4960.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Removal of upper jaw","code_information":[{"code":"31230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5438.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5544.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Nasal endoscopy dx","code_information":[{"code":"31231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.12,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":175.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":178.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.03,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.82,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":279.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":250.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Nasal/sinus endoscopy dx","code_information":[{"code":"31233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":367.1,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":367.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":374.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.23,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":548.43,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":491.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Nasal/sinus endoscopy dx","code_information":[{"code":"31235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":432.74,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":432.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":441.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":433.37,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":433.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":441.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.48,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":462.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1633.03,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1633.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1665.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":430.9,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":430.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":439.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Nsl/sins ndsc w/artery lig","code_information":[{"code":"31241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1208.93,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1208.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1232.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Nsl/sinus ndsc rf abltj pnn","code_information":[{"code":"31242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":428.48,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":428.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":436.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Nsl/sinus ndsc cryoabltj pnn","code_information":[{"code":"31243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":428.48,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":428.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":436.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Nsl/sins ndsc total","code_information":[{"code":"31253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1355.42,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1355.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1382.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Revision of ethmoid sinus","code_information":[{"code":"31254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":659.12,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":659.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":672.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":876.37,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":876.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":893.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Exploration maxillary sinus","code_information":[{"code":"31256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":487.63,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":487.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":497.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Nsl/sins ndsc tot w/sphendt","code_information":[{"code":"31257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1209.53,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1209.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1233.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Nsl/sins ndsc sphn tiss rmvl","code_information":[{"code":"31259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1277.9,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1277.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1302.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Endoscopy maxillary sinus","code_information":[{"code":"31267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":720.45,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":720.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":734.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Sinus endoscopy surgical","code_information":[{"code":"31276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1026.03,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1026.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":545.16,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":555.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":634.65,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":634.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":647.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3099.61,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3099.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3160.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3328.55,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3328.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3393.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2681.99,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2681.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2734.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2914.89,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2914.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2972.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3330.94,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3330.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3396.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Sinus endo w/balloon dil","code_information":[{"code":"31295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":427.52,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":427.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":435.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Sinus endo w/balloon dil","code_information":[{"code":"31296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":485.84,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":485.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Sinus endo w/balloon dil","code_information":[{"code":"31297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.14,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":390.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":397.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Nsl/sins ndsc w/sins dilat","code_information":[{"code":"31298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.94,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":707.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of larynx lesion","code_information":[{"code":"31300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3206.19,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3358.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3424.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of larynx","code_information":[{"code":"31360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5652.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Removal of larynx","code_information":[{"code":"31365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6851.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6986.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Partial removal of larynx","code_information":[{"code":"31367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5848.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5963.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Partial removal of larynx","code_information":[{"code":"31368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6467.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6594.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Partial removal of larynx","code_information":[{"code":"31370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5478.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5585.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Partial removal of larynx","code_information":[{"code":"31375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5207.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5309.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Partial removal of larynx","code_information":[{"code":"31380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5134.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5234.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Partial removal of larynx","code_information":[{"code":"31382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5625.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5736.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Laryngoplasty laryngeal sten","code_information":[{"code":"31551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4162.98,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4162.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4244.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Laryngoplasty laryngeal sten","code_information":[{"code":"31552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4015.8,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4015.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4094.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Laryngoplasty laryngeal sten","code_information":[{"code":"31553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4519.24,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4519.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4607.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Laryngoplasty laryngeal sten","code_information":[{"code":"31554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4520.95,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4520.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4609.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Laryngoscop w/arytenoidectom","code_information":[{"code":"31560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":843.65,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":843.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":860.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Larynscop remve cart + scop","code_information":[{"code":"31561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.07,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":923.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":941.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Laryngoscope w/vc inj","code_information":[{"code":"31570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":619.99,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":632.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Laryngoscop w/vc inj + scope","code_information":[{"code":"31571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.76,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":672.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":685.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Largsc w/laser dstrj les","code_information":[{"code":"31572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":488.4,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":488.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":497.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Largsc w/ther injection","code_information":[{"code":"31573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":402.71,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":402.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":410.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Largsc w/njx augmentation","code_information":[{"code":"31574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":404.53,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":404.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":412.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Diagnostic laryngoscopy","code_information":[{"code":"31575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":184.64,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":184.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":188.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.03,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.82,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":279.89,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":250.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Laryngoscopy with biopsy","code_information":[{"code":"31576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":323.29,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":323.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":329.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Largsc w/rmvl foreign bdy(s)","code_information":[{"code":"31577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":361.35,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":361.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":368.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.23,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":548.43,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":491.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Largsc w/removal lesion","code_information":[{"code":"31578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":404.53,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":404.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":412.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Laryngoscopy telescopic","code_information":[{"code":"31579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.99,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":322.99},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":329.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.23,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":548.43,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":491.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Laryngoplasty laryngeal web","code_information":[{"code":"31580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3431.51,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3431.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3498.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Laryngoplasty fx rdctj fixj","code_information":[{"code":"31584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3786.23,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3786.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3860.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Laryngoplasty cricoid split","code_information":[{"code":"31587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.71,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3246.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3310.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reinnervate larynx","code_information":[{"code":"31590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2452.51,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2452.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2500.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Laryngoplasty medialization","code_information":[{"code":"31591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2958.64,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2958.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3016.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Cricotracheal resection","code_information":[{"code":"31592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4679.21,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4679.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4771.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":830.01,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":830.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":846.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1220.59,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1220.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":871.56,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":871.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.04,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":900.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":918.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.04,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":235.92,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":332.11,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":297.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Apply hand/wrist cast","code_information":[{"code":"29085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.14,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":182.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Apply finger cast","code_information":[{"code":"29086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.1,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Apply long arm splint","code_information":[{"code":"29105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":112.56,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Apply forearm splint","code_information":[{"code":"29125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.81,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.66,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.52,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":186.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":167.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Apply forearm splint","code_information":[{"code":"29126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.66,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.66,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.52,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":186.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":167.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of finger splint","code_information":[{"code":"29130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.63,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.66,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.52,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":186.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":167.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of finger splint","code_information":[{"code":"29131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.05,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.05,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.76,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":82.72,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Strapping of chest","code_information":[{"code":"29200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.43,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Strapping of shoulder","code_information":[{"code":"29240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.6,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.66,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.52,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":186.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":167.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Strapping of elbow or wrist","code_information":[{"code":"29260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.22,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.05,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.76,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":82.72,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Strapping of hand or finger","code_information":[{"code":"29280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.76,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.05,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.76,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":82.72,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of hip cast","code_information":[{"code":"29305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.47,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":419.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":427.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of hip casts","code_information":[{"code":"29325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.47,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":470.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":479.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of long leg cast","code_information":[{"code":"29345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.82,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":262.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":267.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Bronchoscopy/lung bx each","code_information":[{"code":"31628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":471.1,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":471.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":480.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Bronchoscopy/needle bx each","code_information":[{"code":"31629","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":500.56,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":500.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":510.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Bronchoscopy dilate/fx repr","code_information":[{"code":"31630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":531.96,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":531.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":542.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Bronchoscopy dilate w/stent","code_information":[{"code":"31631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":606.1,"maximum":9896.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":606.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":618.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Bronchoscopy/lung bx addl","code_information":[{"code":"31632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.23,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Bronchoscopy/needle bx addl","code_information":[{"code":"31633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":168.96,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":168.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":172.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Bronch w/balloon occlusion","code_information":[{"code":"31634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":504.08,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":504.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":513.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Bronchoscopy w/fb removal","code_information":[{"code":"31635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":470.83,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":470.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":480.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Bronchoscopy bronch stents","code_information":[{"code":"31636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":580.25,"maximum":9896.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":580.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":591.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Bronchoscopy stent add-on","code_information":[{"code":"31637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.67,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":207.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Bronchoscopy revise stent","code_information":[{"code":"31638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":658.68,"maximum":9896.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":658.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Bronchoscopy w/tumor excise","code_information":[{"code":"31640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":662.5,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":662.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":675.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Strapping of knee","code_information":[{"code":"29530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.6,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.66,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.52,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":186.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":167.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Strapping of ankle and/or ft","code_information":[{"code":"29540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.04,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Strapping of toes","code_information":[{"code":"29550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.78,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.05,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.76,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":82.72,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of paste boot","code_information":[{"code":"29580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.32,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Apply multlay comprs lwr leg","code_information":[{"code":"29581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.87,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Appl multlay comprs arm/hand","code_information":[{"code":"29584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.33,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Removal/revision of cast","code_information":[{"code":"29700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.33,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Removal/revision of cast","code_information":[{"code":"29705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.44,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Removal/revision of cast","code_information":[{"code":"29710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":219.09,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":219.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":223.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Repair of body cast","code_information":[{"code":"29720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.35,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Windowing of cast","code_information":[{"code":"29730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":119.32,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Wedging of cast","code_information":[{"code":"29740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.48,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":187.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Wedging of clubfoot cast","code_information":[{"code":"29750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":204.88,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":204.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":208.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Jaw arthroscopy/surgery","code_information":[{"code":"29800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1423.4,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1423.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1451.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Jaw arthroscopy/surgery","code_information":[{"code":"29804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1572.78,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1572.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1603.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Shoulder arthroscopy dx","code_information":[{"code":"29805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1251.5,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1251.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1276.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2827.33,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2827.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2882.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2759.96,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2759.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2814.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1570.91,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1570.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1427.75,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1427.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1455.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1585.29,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1585.29},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1616.42},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1448.89,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1448.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1477.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1586.97,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1618.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1810.0,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1810.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1845.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1567.34,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1567.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1598.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":456.23,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":456.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":465.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Arthroscop rotator cuff repr","code_information":[{"code":"29827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2851.59,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2851.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2907.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Arthroscopy biceps tenodesis","code_information":[{"code":"29828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2446.98,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2446.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2495.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Elbow arthroscopy","code_information":[{"code":"29830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1221.63,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1221.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1245.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1316.34,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1316.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1342.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1366.72,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1366.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1393.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1564.61,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1564.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1595.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1406.71,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1406.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1434.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1593.43,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1593.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1624.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Wrist arthroscopy","code_information":[{"code":"29840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1206.34,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1206.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1230.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1306.03,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1306.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1331.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.97,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1336.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1363.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1570.47,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1570.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1399.94,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1399.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1427.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29847","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1460.75,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1460.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1489.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Wrist endoscopy/surgery","code_information":[{"code":"29848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1373.41,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1373.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1400.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1673.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1706.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1554.99,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2485.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2534.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Tibial arthroscopy/surgery","code_information":[{"code":"29855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2084.78,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2084.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2125.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Tibial arthroscopy/surgery","code_information":[{"code":"29856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2651.72,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2651.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2703.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Hip arthroscopy dx","code_information":[{"code":"29860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1754.06,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1754.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1788.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Hip arthro w/fb removal","code_information":[{"code":"29861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1910.92,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1910.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1948.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Hip arthr0 w/debridement","code_information":[{"code":"29862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2178.11,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2178.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2220.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Hip arthr0 w/synovectomy","code_information":[{"code":"29863","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2176.35,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2176.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2219.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Autgrft implnt knee w/scope","code_information":[{"code":"29866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2811.0,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2811.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2866.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Allgrft implnt knee w/scope","code_information":[{"code":"29867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3412.81,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3412.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3479.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Meniscal trnspl knee w/scpe","code_information":[{"code":"29868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4448.81,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4448.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4536.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Knee arthroscopy dx","code_information":[{"code":"29870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1099.53,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1099.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1121.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/drainage","code_information":[{"code":"29871","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1380.53,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1380.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1407.64},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1435.91,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1435.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1464.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1442.43,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1442.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1470.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1330.48,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1330.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1356.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1747.41,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1747.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1781.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29877","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1661.47,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1661.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1694.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29879","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1771.33,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1771.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1806.11},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.44,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1504.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1533.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1448.89,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1448.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1477.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1841.92,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1841.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1878.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2254.34,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2254.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2298.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1658.8,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1658.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1691.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2024.8,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2024.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2064.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1706.43,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1706.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1739.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2017.62,"maximum":10174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2017.62},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2057.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2600.87,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2600.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2651.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3270.93,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3270.93},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3335.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8375.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29891","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1801.0,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1801.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1836.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1716.3,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1716.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1750.0},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Scope plantar fasciotomy","code_information":[{"code":"29893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1165.81,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1165.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1188.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1349.21,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1349.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1375.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29895","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1239.48,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1239.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1263.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29897","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1325.28,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1325.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1351.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1497.38,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1497.38},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1526.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2684.74,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2684.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2737.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Mcp joint arthroscopy dx","code_information":[{"code":"29900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1351.63,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1351.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1378.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Mcp joint arthroscopy surg","code_information":[{"code":"29901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1449.88,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1449.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1478.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Mcp joint arthroscopy surg","code_information":[{"code":"29902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1538.54,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1538.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1568.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Subtalar arthro w/fb rmvl","code_information":[{"code":"29904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1713.91,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1713.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1747.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Subtalar arthro w/exc","code_information":[{"code":"29905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1377.2,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1377.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1404.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Subtalar arthro w/deb","code_information":[{"code":"29906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1745.73,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1745.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1780.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Subtalar arthro w/fusion","code_information":[{"code":"29907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2346.36,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2346.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2392.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Hip arthro w/femoroplasty","code_information":[{"code":"29914","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2651.14,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2651.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2703.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Hip arthro acetabuloplasty","code_information":[{"code":"29915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2717.61,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2717.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2770.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Hip arthro w/labral repair","code_information":[{"code":"29916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2706.44,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2706.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2759.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Drainage of nose lesion","code_information":[{"code":"30000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.04,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":326.98},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":333.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.04,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":235.92,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":332.11,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":297.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Drainage of nose lesion","code_information":[{"code":"30020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":331.24,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":331.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":337.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":521.55,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":537.2,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":756.25,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":678.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Intranasal biopsy","code_information":[{"code":"30100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":184.53,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":184.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":188.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Removal of nose polyp(s)","code_information":[{"code":"30110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":359.48,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":359.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":366.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Removal of nose polyp(s)","code_information":[{"code":"30115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1244.4,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1268.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of intranasal lesion","code_information":[{"code":"30117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1102.15,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1102.15},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1123.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Removal of intranasal lesion","code_information":[{"code":"30118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1901.21,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1901.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1938.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Revision of nose","code_information":[{"code":"30120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1132.37,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1132.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1154.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Removal of nose lesion","code_information":[{"code":"30124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":818.65,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":818.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":834.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Removal of nose lesion","code_information":[{"code":"30125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1758.02,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1758.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1792.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Excise inferior turbinate","code_information":[{"code":"30130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1106.19,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1106.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1127.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Resect inferior turbinate","code_information":[{"code":"30140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":483.2,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":483.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":492.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Partial removal of nose","code_information":[{"code":"30150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2151.66,"maximum":11276.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2151.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2193.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Removal of nose","code_information":[{"code":"30160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2195.57,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2195.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2238.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Injection treatment of nose","code_information":[{"code":"30200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":160.85,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":521.55,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":537.2,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":756.25,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":678.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Nasal sinus therapy","code_information":[{"code":"30210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":276.49,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":276.49},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":281.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Insert nasal septal button","code_information":[{"code":"30220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.72,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":346.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":353.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.66,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":327.31},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":333.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.66,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.52,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":186.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":167.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":555.89,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":555.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":566.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1304.35,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1304.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1329.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Reconstruction of nose","code_information":[{"code":"30400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3263.81,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3263.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3327.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Reconstruction of nose","code_information":[{"code":"30410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3769.45,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3769.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3843.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Reconstruction of nose","code_information":[{"code":"30420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3894.61,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3894.61},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3971.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of nose","code_information":[{"code":"30430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2841.77,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2841.77},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2897.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Revision of nose","code_information":[{"code":"30435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3563.81,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3563.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3633.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of nose","code_information":[{"code":"30450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4680.67,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4680.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4772.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of nose","code_information":[{"code":"30460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2229.67,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2229.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2273.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Revision of nose","code_information":[{"code":"30462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4286.54,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4286.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4370.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair Nasal Stenosis","code_information":[{"code":"30465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2760.34,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2760.34},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2814.54},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Rpr nsl vlv collapse w/implt","code_information":[{"code":"30468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":458.23,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":458.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":467.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Rpr nsl vlv collapse w/rmdlg","code_information":[{"code":"30469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":408.02,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":408.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":416.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair of nasal septum","code_information":[{"code":"30520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1807.91,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1807.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1843.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Repair nasal defect","code_information":[{"code":"30540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1981.13,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1981.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2020.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair nasal defect","code_information":[{"code":"30545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2690.63,"maximum":12885.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2690.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2743.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Release of nasal adhesions","code_information":[{"code":"30560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":402.74,"maximum":5219.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":402.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":410.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":521.55,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":537.2,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":756.25,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":678.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Repair upper jaw fistula","code_information":[{"code":"30580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1242.73,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1242.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1267.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair mouth/nose fistula","code_information":[{"code":"30600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1041.23,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1041.23},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1061.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Intranasal reconstruction","code_information":[{"code":"30620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1798.39,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1798.39},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1833.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5724.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5896.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":8300.85,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7442.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11276.0}]}]},{"description":"Repair nasal septum defect","code_information":[{"code":"30630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1794.65,"maximum":15006.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1794.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1829.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15006.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3206.19,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3302.37,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4648.97,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4168.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Ablate inf turbinate superf","code_information":[{"code":"30801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":402.68,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":402.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":410.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Ablate inf turbinate submuc","code_information":[{"code":"30802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":541.28,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":541.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":551.91},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.45,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2175.65,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.66,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":155.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":158.12},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.66,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.52,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":186.56,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":167.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Bronchoscopy treat blockage","code_information":[{"code":"31641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":680.6,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":680.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Diag bronchoscope/catheter","code_information":[{"code":"31643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.97,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":462.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Bronchoscopy clear airways","code_information":[{"code":"31645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":394.71,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":394.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":402.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Bronchoscopy reclear airway","code_information":[{"code":"31646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":378.23,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":380.88},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":388.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.23,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":548.43,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":491.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Bronchial valve init insert","code_information":[{"code":"31647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":550.03,"maximum":9896.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":550.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":560.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Bronchial valve remov init","code_information":[{"code":"31648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":530.5,"maximum":9338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":530.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":540.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Bronchial valve remov addl","code_information":[{"code":"31649","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":179.08,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179.08},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":182.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.24,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.87,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2495.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2237.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Bronchial valve addl insert","code_information":[{"code":"31651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.67,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":207.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Bronch ebus samplng 1/2 node","code_information":[{"code":"31652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":590.48,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":590.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":602.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Bronch ebus samplng 3/> node","code_information":[{"code":"31653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":654.89,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":654.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":667.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3713.63,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5227.92,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4687.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Bronch ebus ivntj perph les","code_information":[{"code":"31654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":179.82,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179.82},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Bronch thermoplsty 1 lobe","code_information":[{"code":"31660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":508.97,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":508.97},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":518.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Bronch thermoplsty 2/> lobes","code_information":[{"code":"31661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":537.65,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":537.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":548.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.6,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":9896.04,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Bronchial brush biopsy","code_information":[{"code":"31717","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":284.96,"maximum":4765.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":284.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":290.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4765.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.23,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":548.43,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":491.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2076.72,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2076.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2117.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1933.86,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1933.86},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1971.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2073.09,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2073.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2113.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Revision of foot bones","code_information":[{"code":"28737","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1848.83,"maximum":18002.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1848.83},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1885.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12885.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.54,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.0,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":18002.53,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16140.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1645.16,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1645.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1677.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.32,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1536.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1566.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":892.57,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":892.57},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":910.09},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1529.74,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1529.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1559.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.06,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.57,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":10174.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9122.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Amputation of midfoot","code_information":[{"code":"28800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1406.96,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1406.96},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1434.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Amputation thru metatarsal","code_information":[{"code":"28805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1886.75,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1886.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1923.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Amputation toe & metatarsal","code_information":[{"code":"28810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1127.58,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1127.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1149.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Amputation of toe","code_information":[{"code":"28820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":475.17,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":475.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":484.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Partial amputation of toe","code_information":[{"code":"28825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":463.4,"maximum":7351.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":463.4},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":472.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.16,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.08,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4588.03,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4113.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.0}]}]},{"description":"Hi enrgy eswt plantar fascia","code_information":[{"code":"28890","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":595.21,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":595.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":606.9},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1554.99,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.64,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2254.74,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2021.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Application of body cast","code_information":[{"code":"29000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.47,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":533.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":543.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of body cast","code_information":[{"code":"29010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.47,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":425.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":433.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of body cast","code_information":[{"code":"29015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.47,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":478.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":488.18},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of body cast","code_information":[{"code":"29035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.47,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":381.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":388.8},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of body cast","code_information":[{"code":"29040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.47,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":459.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":468.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of body cast","code_information":[{"code":"29044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.14,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":443.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":451.92},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":227.86,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of body cast","code_information":[{"code":"29046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.47,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":497.94},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":507.72},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of figure eight","code_information":[{"code":"29049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.21,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":185.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":188.85},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of shoulder cast","code_information":[{"code":"29055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.47,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":365.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":372.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of shoulder cast","code_information":[{"code":"29058","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":248.74,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":248.74},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":253.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of long arm cast","code_information":[{"code":"29065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":180.79,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180.79},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":184.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Application of forearm cast","code_information":[{"code":"29075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":165.55,"maximum":965.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":165.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":168.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.47,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.59,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":392.19,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.0}]}]},{"description":"Prcrd drg 0-5yr or w/anomly","code_information":[{"code":"33018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":871.17,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":871.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Perq prcrd drg insj cath ct","code_information":[{"code":"33019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":631.13,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":631.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":643.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Incision of heart sac","code_information":[{"code":"33020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2492.52,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2492.52},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2541.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Incision of heart sac","code_information":[{"code":"33025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2331.48,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2331.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2377.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Partial removal of heart sac","code_information":[{"code":"33030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6046.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6165.04},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Partial removal of heart sac","code_information":[{"code":"33031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7472.47},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7619.2},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Resect heart sac lesion","code_information":[{"code":"33050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3050.66,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3050.66},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3110.56},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Removal of heart lesion","code_information":[{"code":"33120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6317.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6441.46},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Removal of heart lesion","code_information":[{"code":"33130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4115.51},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4196.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Heart revascularize (tmr)","code_information":[{"code":"33140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4025.0,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4685.67},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4777.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Heart Tmr W/Other Procedure","code_information":[{"code":"33141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":398.45,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":398.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":406.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Insert epicard eltrd open","code_information":[{"code":"33202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2331.48,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2331.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2377.26},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Insert epicard eltrd endo","code_information":[{"code":"33203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2452.59,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2452.59},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2500.75},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Insert heart pm atrial","code_information":[{"code":"33206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1361.69,"maximum":29009.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1361.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1388.43},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29009.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.51,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10410.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14655.9,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13139.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Insert heart pm ventricular","code_information":[{"code":"33207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1434.48,"maximum":29009.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1434.48},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1462.65},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29009.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.51,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10410.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14655.9,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13139.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Insrt heart pm atrial & vent","code_information":[{"code":"33208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1553.5,"maximum":29009.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1553.5},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1584.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29009.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.51,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10410.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14655.9,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13139.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17286.0}]}]},{"description":"Insert electrd/pm cath sngl","code_information":[{"code":"33210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":485.07,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":485.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":494.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8002.65,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11603.84,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10403.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Insert card electrodes dual","code_information":[{"code":"33211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":507.32,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":507.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":517.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8002.65,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11603.84,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10403.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Insert pulse gen sngl lead","code_information":[{"code":"33212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":969.07,"maximum":29009.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":969.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":988.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29009.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8002.65,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11603.84,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10403.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Insert pulse gen dual leads","code_information":[{"code":"33213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1015.14,"maximum":29009.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1015.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1035.07},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29009.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.51,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10410.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14655.9,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13139.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Upgrade of pacemaker system","code_information":[{"code":"33214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1435.45,"maximum":29009.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1435.45},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1463.63},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29009.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.51,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10410.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14655.9,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13139.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17286.0}]}]},{"description":"Reposition pacing-defib lead","code_information":[{"code":"33215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":931.87,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":931.87},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":950.16},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3053.41,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3145.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4427.45,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3969.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Insert 1 electrode pm-defib","code_information":[{"code":"33216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1112.21,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1112.21},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1134.05},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8002.65,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11603.84,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10403.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Insert 2 electrode pm-defib","code_information":[{"code":"33217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1104.35,"maximum":15648.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1104.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8002.65,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11603.84,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10403.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15648.0}]}]},{"description":"Repair lead pace-defib one","code_information":[{"code":"33218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1166.06,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1166.06},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1188.95},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3613.8,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3722.21,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5240.0,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4697.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Repair lead pace-defib dual","code_information":[{"code":"33220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1142.6,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1142.6},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1165.03},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3613.8,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3722.21,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5240.0,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4697.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Insert pulse gen mult leads","code_information":[{"code":"33221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1071.37,"maximum":27008.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1071.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1092.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18626.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19185.66,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":27008.94,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24214.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Relocation pocket pacemaker","code_information":[{"code":"33222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1027.1,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1027.1},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1047.27},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Relocate pocket for defib","code_information":[{"code":"33223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1226.36,"maximum":5235.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1226.36},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1250.44},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.28,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.14,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":2893.15,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2593.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5235.0}]}]},{"description":"Insert pacing lead & connect","code_information":[{"code":"33224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1535.13,"maximum":29009.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1535.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1565.28},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29009.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.51,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10410.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14655.9,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13139.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17286.0}]}]},{"description":"L ventric pacing lead add-on","code_information":[{"code":"33225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1385.81,"maximum":29009.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1385.81},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1413.02},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29009.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17286.0}]}]},{"description":"Reposition l ventric lead","code_information":[{"code":"33226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1470.32,"maximum":10993.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1470.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1499.19},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3053.41,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3145.02,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":4427.45,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3969.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove&replace pm gen singl","code_information":[{"code":"33227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1017.69,"maximum":16736.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1017.69},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1037.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16736.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8002.65,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11603.84,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10403.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Remv&replc pm gen dual lead","code_information":[{"code":"33228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1062.68,"maximum":16736.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1062.68},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1083.55},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16736.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.51,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10410.74,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":14655.9,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13139.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Remv&replc pm gen mult leads","code_information":[{"code":"33229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1117.3,"maximum":27008.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1117.3},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1139.24},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16736.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18626.86,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19185.66,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":27008.94,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24214.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.0}]}]},{"description":"Insrt pulse gen w/dual leads","code_information":[{"code":"33230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1124.7,"maximum":32783.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1124.7},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1146.78},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21510.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22155.78,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":31190.17,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27963.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32783.0}]}]},{"description":"Insrt pulse gen w/mult leads","code_information":[{"code":"33231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1202.71,"maximum":44013.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1202.71},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1226.33},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10993.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30354.34,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31264.97,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":44013.79,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39460.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32783.0}]}]},{"description":"Removal of pm generator","code_information":[{"code":"33233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":696.22,"maximum":11603.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":696.22},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":709.89},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5219.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8002.65,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.72,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":11603.84,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10403.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal of pacemaker system","code_information":[{"code":"33234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1450.76,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1450.76},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1479.25},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3613.8,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3722.21,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5240.0,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4697.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Removal pacemaker electrode","code_information":[{"code":"33235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1905.17,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1905.17},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1942.58},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3613.8,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3722.21,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5240.0,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4697.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.0}]}]},{"description":"Remove electrode/thoracotomy","code_information":[{"code":"33236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2361.01,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2361.01},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2407.37},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Remove electrode/thoracotomy","code_information":[{"code":"33237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2535.53,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2535.53},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2585.32},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Remove electrode/thoracotomy","code_information":[{"code":"33238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2866.13,"maximum":10593.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2866.13},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2922.41},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10593.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4025.0}]}]},{"description":"Insrt pulse gen w/singl lead","code_information":[{"code":"33240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1105.14,"maximum":60327.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1105.14},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.84},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60327.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21510.46,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22155.78,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":31190.17,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27963.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32783.0}]}]},{"description":"Remove pulse generator","code_information":[{"code":"33241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":642.73,"maximum":13923.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":642.73},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":655.35},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13923.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3613.8,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Advantage Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3722.21,"additional_payer_notes":"APC"},{"payer_name":"Buckeye","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":5240.0,"additional_payer_notes":"APC"},{"payer_name":"CareSource","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4697.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","p